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1.
Medicine (Baltimore) ; 100(25): e26387, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160417

RESUMO

RATIONALE: Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature. PATIENT CONCERNS: A newborn at 30+4 weeks' gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock. DIAGNOSES: Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly. INTERVENTIONS: Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively. OUTCOMES: Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months' corrected age. LESSONS: This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.


Assuntos
Leucomalácia Periventricular/microbiologia , Sepse Neonatal/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus agalactiae/isolamento & purificação , Administração Intravenosa , Antibacterianos/administração & dosagem , Corioamnionite/diagnóstico , Corioamnionite/microbiologia , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/microbiologia , Quimioterapia Combinada/métodos , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/microbiologia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doenças Infecciosas , Leucomalácia Periventricular/diagnóstico , Leucomalácia Periventricular/patologia , Imageamento por Ressonância Magnética , Masculino , Idade Materna , Sepse Neonatal/diagnóstico , Sepse Neonatal/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Recidiva , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Substância Branca/diagnóstico por imagem , Substância Branca/microbiologia , Substância Branca/patologia , Adulto Jovem
2.
S Afr Med J ; 110(9): 846-849, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32880265

RESUMO

An HIV-positive mother infected her daughter with extensively drug-resistant Mycobacterium tuberculosis. Despite adhering to the then current guidelines for prevention, the infant was diagnosed with extensively drug-resistant pulmonary tuberculosis at the age of 4 months and developed tuberculous meningitis. After a short delay, appropriate treatment was initiated, followed by an inhospital stay at a specialised hospital. The infant became generally well, but had delayed neurological development. Secondary hydrocephalus due to tuberculous meningitis required a ventriculoperitoneal shunt. After 2 years of microbiologically and clinically effective tuberculosis treatment and several shunt complications, the HIV-negative child died at the age of 28 months ‒ with radiological signs of a shunt infection. The reason for the fatal outcome was probably related to inadequate risk reduction of airborne mother-to-child transmission, inappropriate chemoprophylaxis and delayed initiation of adequate treatment.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Extensivamente Resistente a Medicamentos/transmissão , Transmissão Vertical de Doenças Infecciosas , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/transmissão , Adulto , Antituberculosos/farmacologia , Evolução Fatal , Feminino , Humanos , Hidrocefalia/microbiologia , Lactente , Recém-Nascido , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Meníngea/microbiologia , Tuberculose Pulmonar/complicações
3.
World Neurosurg ; 138: e883-e891, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247798

RESUMO

OBJECTIVE: Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Hydrocephalus can develop after intracranial dissemination, and management of this disease entity is difficult. We present our institutional experience with shunting coccidioidomycosis-related hydrocephalus. METHODS: A cohort of patients with coccidioidomycosis-related hydrocephalus undergoing an intracranial shunt placement were retrospectively identified over a 24-year period. Demographics and treatment characteristics were obtained from the electronic medical record. RESULTS: Thirty patients undergoing 83 procedures were identified, with a median follow-up of 19.4 months. The average age of the cohort was 43 years at the time of initial shunt placement. Most patients (66.7%) had ≥1 shunt failure, and the average number of revisions required was 2.6 for patients who had shunt failure. The average shunt valve pressure threshold required was 5.5 cm H2O, and patients who harbored the disease for a longer period (>7 months) had a lower pressure setting for initial shunt valves. Shunts without an antisiphon component were more likely to be failure free on multivariate analysis (odds ratio, 9.2; 95% confidence interval, 2.4-35.7). Death was associated with a longer diagnosis-to-shunt time interval, and patients having been diagnosed with intracranial disease for more than 10 months before shunt placement had significantly higher rates of death on follow-up. CONCLUSIONS: Patients with coccidioidomycosis-related hydrocephalus typically have normal to low pressure setting requirements, high shunt failure rates, prolonged hospitalizations, and mortality. In this disease context, shunt valves without an antisiphon component are associated with lower shunt failure rates.


Assuntos
Coccidioidomicose/complicações , Hidrocefalia/microbiologia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Forensic Sci Med Pathol ; 16(1): 143-151, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31471869

RESUMO

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.


Assuntos
Tuberculose/patologia , Autopsia , Encéfalo/microbiologia , Encéfalo/patologia , Transmissão de Doença Infecciosa/prevenção & controle , Empiema Tuberculoso/patologia , Epididimite/microbiologia , Epididimite/patologia , Patologia Legal , Granuloma/patologia , Humanos , Hidrocefalia/microbiologia , Hidrocefalia/patologia , Controle de Infecções , Rim/microbiologia , Rim/patologia , Joelho/microbiologia , Joelho/patologia , Pulmão/patologia , Linfonodos/microbiologia , Linfonodos/patologia , Masculino , Meninges/microbiologia , Meninges/patologia , Microscopia , Mycobacterium tuberculosis/patogenicidade , Necrose/patologia , Coluna Vertebral/microbiologia , Coluna Vertebral/patologia , Traqueia/microbiologia , Traqueia/patologia
6.
Sci Rep ; 9(1): 18442, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31804566

RESUMO

Twenty-seven previously healthy (of 36 consecutive eligible patients), HIV-negative cryptococcal meningoencephalitis (CM) patients underwent comprehensive neuropsychological evaluation during the late post-treatment period (1.3-4 years post diagnosis), assessing attention, language, learning, memory, visuospatial, executive function, information processing, psychomotor functioning, as well as mood symptoms. Seven of eight domains (all except attention) showed increased percentages of CM patients scoring in the less than 16th percentile range compared to standardized normative test averages, adjusted for education level and age. Comparison with a matched archival dataset of mild cognitive impairment/Alzheimer's disease patients showed that CM patients exhibited relative deficits in psychomotor and executive function with fewer deficits in memory and learning, consistent with a frontal-subcortical syndrome. MRI evaluation at the time of testing demonstrated an association of lower neuropsychological functioning with ventriculomegaly. These studies suggest that CM should be included in the list of treatable causes of dementia in neurological work ups. Future studies are needed to identify diagnostic and treatment regimens that may enhance neurological function after therapy.


Assuntos
Transtornos Cognitivos/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Lobo Frontal/fisiopatologia , Meningite Criptocócica/complicações , Meningoencefalite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Antifúngicos/uso terapêutico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Conjuntos de Dados como Assunto , Função Executiva/fisiologia , Feminino , Lobo Frontal/diagnóstico por imagem , Gliose/diagnóstico , Gliose/microbiologia , Gliose/fisiopatologia , HIV-1/isolamento & purificação , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/microbiologia , Hidrocefalia/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/microbiologia , Meningite Criptocócica/fisiopatologia , Meningoencefalite/tratamento farmacológico , Meningoencefalite/microbiologia , Meningoencefalite/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Síndrome , Adulto Jovem
7.
Tidsskr Nor Laegeforen ; 139(16)2019 11 05.
Artigo em Norueguês | MEDLINE | ID: mdl-31686480

RESUMO

Nowadays severe illness in neonates is fortunately rare in Norway. However, newborns present with non-specific symptoms, making diagnostics in this age group challenging, and neonatologists need to think broadly in order not to overlook serious illness. We present the case of a nine-day-old who was severely ill when she arrived at hospital. She was born in gestational week 37 after a normal pregnancy. The birth was complicated by shoulder dystocia, rupture of the umbilical cord and fracture of the clavicle. Thereafter she had a normal stay in the maternity ward for three days. At home she appeared healthy and gained weight until she returned to hospital after thirteen hours of poor feeding, irritability and fever. The symptoms turned out to be caused by bacterial meningitis. During the first week of hospitalisation she developed ventriculitis, brain abscesses and sinus vein thrombosis. It was later discovered that she had severely impaired hearing, and thereafter she developed hydrocephalus requiring surgical drainage. The mortality from neonatal bacterial meningitis has dropped from almost 50 % in the 1970s to less than 10 % today, but the morbidity has remained unchanged. It is crucial that clinicians are alert to this diagnosis, as delayed treatment can worsen the prognosis.


Assuntos
Meningite devida a Escherichia coli , Abscesso Encefálico/microbiologia , Ventriculite Cerebral/microbiologia , Escherichia coli/isolamento & purificação , Feminino , Febre/microbiologia , Humanos , Hidrocefalia/microbiologia , Recém-Nascido , Imageamento por Ressonância Magnética , Meningite devida a Escherichia coli/complicações , Meningite devida a Escherichia coli/diagnóstico , Meningite devida a Escherichia coli/tratamento farmacológico , Trombose dos Seios Intracranianos/microbiologia
8.
Int J Infect Dis ; 88: 102-109, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31499210

RESUMO

BACKGROUND: Ventriculoperitoneal (VP) shunting in cryptococcal meningitis (CM) patients with high intracranial pressure (ICP) has been studied extensively. METHODS: A total of 74 CM patients with ICP were identified, including 27 patients with or without ventriculomegaly receiving VP shunting. RESULTS: Through retrospective analysis, there was an obvious decline in ICP as well as Cryptococcus count after VP shunting. Damage to the cranial nerves was improved after the surgery. For those patients receiving VP shunting, there was an obvious decline in ICP as well as Cryptococcus count, with less usage of mannitol. Hydrocephalus or ventriculomegaly was improved, and both the clearance time of Cryptococcus and the hospitalization time were shortened (p<0.05). The complications of VP shunting were not common. CONCLUSIONS: For patients diagnosed with CM and with apparent ICP, VP shunting can be considered regardless of whether there is damage to the cranial nerves or hydrocephaly.


Assuntos
Hipertensão Intracraniana/cirurgia , Meningite Criptocócica/cirurgia , Adulto , Cryptococcus/genética , Cryptococcus/isolamento & purificação , Cryptococcus/fisiologia , Feminino , Hospitalização , Humanos , Hidrocefalia/microbiologia , Hidrocefalia/cirurgia , Hipertensão Intracraniana/microbiologia , Hipertensão Intracraniana/fisiopatologia , Pressão Intracraniana , Masculino , Meningite Criptocócica/microbiologia , Meningite Criptocócica/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Derivação Ventriculoperitoneal
9.
Exp Clin Transplant ; 16 Suppl 1(Suppl 1): 179-182, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29528023

RESUMO

Neurologic complications after solid-organ transplant reveal a great spectrum of pathologies. Intracranial hemorrhages, cerebral ischemic lesions, infarctions, lymphoproliferative disorders, and infections, including aspergillosis, have been observed after liver transplant. Fungi constitute nearly 5% of all central nervous system infections, mainly occurring in immunocompromised patients. The most common causative agent is Aspergillus species. It presents either as maxillary sinusitis or pulmonary infection. Brain involvement of Aspergillus carries a high rate of mortality. Aspergillosis presents in the forms of meningitis, mycotic aneurysms, infarctions, and mass lesions. Aspergillosis does not have a specific radiologic appearance. Parenchymal aspergillosis has heterogenous signal intensity (hypointense on T1-weighted and hyperintense on T2-weighted images). Here, we present 3 patients who underwent solid-organ transplant and developed central nervous system aspergillosis. Different modalities of neurosurgical intervention were performed in combination with chemotherapy as part of their fungal therapy.


Assuntos
Abscesso Encefálico/microbiologia , Hidrocefalia/microbiologia , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Neuroaspergilose/microbiologia , Infecções Oportunistas/microbiologia , Adulto , Antifúngicos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/imunologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/tratamento farmacológico , Hidrocefalia/imunologia , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroaspergilose/diagnóstico por imagem , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/imunologia , Infecções Oportunistas/diagnóstico por imagem , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
BMJ Case Rep ; 20172017 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-29025781

RESUMO

Communicating hydrocephalus may complicate infantile bacterial meningitis, typically presenting with systemic features of infection. We report a rare case of 'subclinical meningoventriculitis' causing obstructive hydrocephalus and its challenging management. A healthy 10-week-old immunocompetent male patient presented with failure to thrive and vomiting, secondary to presumed gastro-oesophageal reflux. The child was neurologically alert, afebrile with normal inflammatory markers. Progressive macrocephaly prompted an MRI confirming triventricular hydrocephalus secondary to aqueductal stenosis. An endoscopic third ventriculostomy was performed however abandoned intraoperatively due to the unexpected finding of intraventricular purulent cerebrospinal fluid. A 6-week course of intravenous ceftriaxone was commenced for Escherichia coli meningoventriculitis. However, the child was readmitted 18 days postoperatively with acute hydrocephalus requiring a ventricular washout and staged ventriculoperitoneal shunt insertion at 4 weeks. Serial head circumference measurements are paramount in the assessment of a paediatric patient. In an immunocompetent child, a subclinical fibropurulent meningoventriculitis can result in several management challenges.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Ventriculite Cerebral/microbiologia , Hidrocefalia/microbiologia , Meningoencefalite/microbiologia , Politetrafluoretileno/uso terapêutico , Infecções Urinárias/terapia , Amoxicilina/uso terapêutico , Ventriculite Cerebral/complicações , Ventriculite Cerebral/terapia , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/etiologia , Hidrocefalia/terapia , Recém-Nascido , Injeções , Masculino , Meningoencefalite/complicações , Meningoencefalite/terapia , Resultado do Tratamento , Ureter , Ventriculostomia
11.
Clin Infect Dis ; 65(8): 1298-1307, 2017 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-28605426

RESUMO

Background: Tuberculous meningitis (TBM) leads to death or disability in half the affected individuals. Tools to assess severity and predict outcome are lacking. Neurospecific biomarkers could serve as markers of the severity and evolution of brain injury, but have not been widely explored in TBM. We examined biomarkers of neurological injury (neuromarkers) and inflammation in pediatric TBM and their association with outcome. Methods: Blood and cerebrospinal fluid (CSF) of children with TBM and hydrocephalus taken on admission and over 3 weeks were analyzed for the neuromarkers S100B, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), in addition to multiple inflammatory markers. Results were compared with 2 control groups: patients with (1) a fatty filum (abnormal filum terminale of the spinal cord); and (2) pulmonary tuberculosis (PTB). Imaging was conducted on admission and at 3 weeks. Outcome was assessed at 6 months. Results: Data were collected from 44 patients with TBM (cases; median age, 3.3 [min-max 0.3-13.1] years), 11 fatty filum controls (median age, 2.8 [min-max 0.8-8] years) and 9 PTB controls (median age, 3.7 [min-max 1.3-11.8] years). Seven cases (16%) died and 16 (36%) had disabilities. Neuromarkers and inflammatory markers were elevated in CSF on admission and for up to 3 weeks, but not in serum. Initial and highest concentrations in week 1 of S100B and NSE were associated with poor outcome, as were highest concentration overall and an increasing profile over time in S100B, NSE, and GFAP. Combined neuromarker concentrations increased over time in patients who died, whereas inflammatory markers decreased. Cerebral infarcts were associated with highest overall neuromarker concentrations and an increasing profile over time. Tuberculomas were associated with elevated interleukin (IL) 12p40, interferon-inducible protein 10, and monocyte chemoattractant protein 1 concentrations, whereas infarcts were associated with elevated tumor necrosis factor α, macrophage inflammatory protein 1α, IL-6, and IL-8. Conclusions: CSF neuromarkers are promising biomarkers of injury severity and are predictive of mortality. An increasing trend suggested ongoing brain injury, even though markers of inflammation declined with treatment. These findings could offer novel insight into the pathophysiology of TBM.


Assuntos
Biomarcadores , Infarto Cerebral , Hidrocefalia , Inflamação , Tuberculose Meníngea , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Infarto Cerebral/sangue , Infarto Cerebral/líquido cefalorraquidiano , Infarto Cerebral/microbiologia , Pré-Escolar , Feminino , Proteína Glial Fibrilar Ácida/sangue , Proteína Glial Fibrilar Ácida/líquido cefalorraquidiano , Humanos , Hidrocefalia/sangue , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/microbiologia , Lactente , Recém-Nascido , Inflamação/sangue , Inflamação/líquido cefalorraquidiano , Inflamação/microbiologia , Masculino , Fosfopiruvato Hidratase/sangue , Fosfopiruvato Hidratase/líquido cefalorraquidiano , Estudos Prospectivos , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/líquido cefalorraquidiano , Tuberculose Meníngea/sangue , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/complicações , Tuberculose Meníngea/epidemiologia
12.
BMC Infect Dis ; 17(1): 359, 2017 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28532447

RESUMO

BACKGROUND: Disseminated cryptococcosis is a rare and fatal disease, and limited data exist regarding it in children. This study aimed to investigate the clinical characteristics of disseminated cryptococcosis in previously healthy children in China. METHODS: Hospitalized patients with disseminated cryptococcosis were enrolled during January 1996 to December 2015 in Beijing Children's Hospital, Capital Medical University, China. Data on clinical manifestations, laboratory tests, treatment, and prognosis were evaluated. RESULTS: A total of 52 pediatric patients with no underlying disease were enrolled, including 38 boys and 14 girls. Only 10 cases had a history of exposure to pigeon droppings. Fever, cough, and hepatomegaly were 3 main manifestations of disseminated cryptococcosis. However, headache was more common in patients with central nervous system (CNS) invasion than in patients with non-CNS invasion (P < 0.05). Lung (96.2%, 50/52) was the most commonly invaded organ, but only 9.6% (5/52) of patients had respiratory signs. The most common findings on chest imaging were hilar or mediastinal lymphadenopathy (46.8%, 22/47), and nodules (44.7%, 21/47), including small nodules in a scattered distribution (57.1%, 12/21) or miliary distribution (42.9%, 9/25), especially localized in subpleural area. Subsequent invasion occurred in the CNS, abdomen lymph nodes, liver, spleen, peripheral lymph nodes, and skin. In all patients, 42.3% (22/52) and 51.9% (27/52) had elevated eosinophils or IgE, respectively. The positive rate of serum cryptococcal antigen was higher, especially in patients with CNS invasion (approximately 83.3%), than with other primary methods used for pathogen detection, including cerebrospinal fluid (CSF) cryptococcal antigen, cultures of blood, bone marrow, or CSF, and CSF ink staining. The overall mortality rate of pediatric patients in our study was 11.5% (6/52). Some cases had long-term sequela, including hydrocephalus, cirrhosis, or blindness. CONCLUSIONS: Disseminated cryptococcosis can occur in previously healthy or immunocompetent children in China. Lung and CNS were most commonly invaded by this disease. Furthermore, most cases usually showed no obvious or specific symptoms or signs, and therefore pediatricians should pay more careful attention to identify this disease.


Assuntos
Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Criptococose/etiologia , Antígenos de Fungos/sangue , Criança , Pré-Escolar , China , Tosse/microbiologia , Criptococose/tratamento farmacológico , Eosinófilos/patologia , Feminino , Febre/microbiologia , Cefaleia/microbiologia , Hepatomegalia/microbiologia , Humanos , Hidrocefalia/microbiologia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Linfonodos/patologia , Masculino , Prognóstico , Radiografia Torácica , Estudos Retrospectivos
13.
Indian J Tuberc ; 64(2): 109-118, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28410693

RESUMO

Central nervous system tuberculosis (TB) is the most severe extra pulmonary TB having a high mortality and morbidity. OBJECTIVE: To study the various clinical, biochemical, and radiological spectrum of intracranial TB. MATERIALS AND METHOD: Ninety-three patients were enrolled in this prospective study after ethical clearance and consent from August 2013 to May 2015. The entire clinical course with complications and predictors of mortality were assessed. RESULTS: 36 females (38.7%) and 57 males (61.3%) were included whose mean age of presentation was 32.3±17.05 years. Alcohol was the most common risk factor seen in 19.4%. Headache (90.3%) was the most common symptom. Co-infection with human immunodeficiency virus, cryptococcal, and toxoplasmosis were seen in 11, 3, and 2 patients, respectively. Cerebrospinal fluid analysis showed acid-fast bacilli in 1 patient; polymerase chain reaction for TB and BACTEC was positive in one and three patients, respectively. Neuroimaging showed basal exudates (21.7%), tuberculoma (28.6%), brain edema (27%), hydrocephalus (32.9%), infarct (21%), and abscess (2.9%). Complications were noted such as brain edema (24.7%), vasculitis (26.9%), hydrocephalus (17.2%), hyponatremia (11.8%), drug-induced hepatitis (4.3%), and drug rash in 5 patients (5.4%). A total of 25 patients (26.9%) died and 38 patients (40.9%) developed neurological sequelae like hemiparesis, paraparesis, visual loss, and hearing loss. Logistic regression showed that a Glasgow scale of <10, British Medical Research Council stage 3, and vasculitis were associated with poor outcome. CONCLUSION: Lack of sensitive diagnostic method and criteria makes central nervous system TB a challenge where early diagnosis and prompt management is required.


Assuntos
Abscesso Encefálico/microbiologia , Cefaleia/microbiologia , Tuberculoma Intracraniano/complicações , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico por imagem , Adolescente , Adulto , Idoso , Abscesso Encefálico/diagnóstico por imagem , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/microbiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/microbiologia , Criança , Pré-Escolar , Coinfecção , Feminino , Perda Auditiva/microbiologia , Hospitais , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/microbiologia , Índia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Paraparesia/microbiologia , Fatores de Risco , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/líquido cefalorraquidiano , Tuberculose Meníngea/líquido cefalorraquidiano , Transtornos da Visão/microbiologia , Adulto Jovem
14.
J Infect Chemother ; 23(10): 713-716, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28408303

RESUMO

We report an infant with hydrocephalus as the initial manifestation of Mycoplasma hominis-associated meningitis, who recovered without appropriate antimicrobial treatment. The analysis of the 16S rRNA gene by polymerase chain reaction amplification using universal primers and pathogen-specific primers was useful for the diagnosis and the investigation of serial detection status of the pathogen. This method may be helpful for the assessment of the frequency and the prediction of severity in M. hominis-associated central nervous system infection in infants, and investigating the association between M. hominis and the development of hydrocephalus.


Assuntos
Hidrocefalia/microbiologia , Meningite/microbiologia , Infecções por Mycoplasma/microbiologia , Mycoplasma hominis/patogenicidade , Humanos , Lactente , Masculino
15.
Expert Rev Anti Infect Ther ; 15(6): 629-635, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28343419

RESUMO

BACKGROUND: Tuberculosis is prevalent in China, which is the second greatest contributor to the global tuberculosis burden. Tuberculosis meningitis (TBM) is the most severe disease form but few reports describe long-term clinical outcomes and prognostic factors. Thus, we studied these features in Chinese TBM patients. METHODS: A retrospective follow-up study was used to collect clinical features and outcomes of adult TB meningitis at the First Affiliated Hospital of Chongqing Medical University from June 2012 to August 2015. Univariate analysis and multivariate analysis were used to identify predictive factors associated with outcomes at discharge and follow-up. RESULTS: TBM patients (N = 154) were a median age of 41 years (range: 16-82 years). Median time to follow-up was 26.4 months (range: 9.3-46.5 months) and 31% had poor outcomes at follow-up and limb weakness (p = 0.016), lower GCS scores (p < 0.001), cranial-nerve palsy (p = 0.024), and hydrocephalus (p = 0.009) were closely associated with these poor outcomes. Furthermore, a high neutrophil to lymphocytes ratio, high D-dimer, a low albumin to globulin ratio and slow background of EEG associated with poor outcomes as well. CONCLUSIONS: Mortality and disability associated with TBM are high in China. Limb weakness, GCS scores, cranial-nerve palsy and hydrocephalus were independent predictors of poor outcomes, and AGR, NLR, D-dimer, and EEG abnormalities may be prognostic factors of TBM.


Assuntos
Antituberculosos/uso terapêutico , Hidrocefalia/diagnóstico , Mycobacterium tuberculosis/efeitos dos fármacos , Doenças do Nervo Troclear/diagnóstico , Tuberculose Meníngea/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Eletrocorticografia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Seguimentos , Humanos , Hidrocefalia/tratamento farmacológico , Hidrocefalia/microbiologia , Hidrocefalia/patologia , Linfócitos/efeitos dos fármacos , Linfócitos/imunologia , Linfócitos/microbiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Mycobacterium tuberculosis/crescimento & desenvolvimento , Mycobacterium tuberculosis/patogenicidade , Neutrófilos/efeitos dos fármacos , Neutrófilos/imunologia , Neutrófilos/microbiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/metabolismo , Soroglobulinas/metabolismo , Doenças do Nervo Troclear/sangue , Doenças do Nervo Troclear/tratamento farmacológico , Doenças do Nervo Troclear/patologia , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/microbiologia , Tuberculose Meníngea/patologia
16.
BMC Infect Dis ; 16(1): 573, 2016 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-27756256

RESUMO

BACKGROUND: Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome. METHODS: A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion. RESULTS: The study enrolled from October 2009 to March 2011. Median age was 32.5 months; sex distribution was equal. Median duration of symptoms was 18.5 days and time from admission to treatment initiation was 11 days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33 %) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6 %. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p = 0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p < 0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p = 0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p < 0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5 years) and hydrocephalus were also associated with the combined endpoint of death or disability. CONCLUSIONS: Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.


Assuntos
Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/mortalidade , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/microbiologia , Lactente , Tempo de Internação , Modelos Logísticos , Perda de Seguimento , Masculino , Prognóstico , Estudos Prospectivos , Punção Espinal , Resultado do Tratamento , Tuberculose Meníngea/etiologia , Vietnã
17.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-27500777

RESUMO

Substantiation of the shunt failure diagnosis and subsequent consideration of indications for surgical elimination of the malfunction is a laborious and challenging process. Identification of a malfunction in doubtful cases requires, in addition to standard examinations, extra diagnostic procedures, which may delay making a decision for several weeks to several months. The article describes a case of mechanical CSF shunt malfunction (breakage and failure of a peritoneal catheter in a 7-year-old girl) with intracranial hypertension symptoms, but without typical enlargement of the brain ventricles. According to the medical history, congenital hydrocephalus in the child was accompanied by an inflammatory process of bacterial and viral etiology. The absence of brain ventricle enlargement was shown not to exclude a probability of shunt malfunction. In this case, a specific phenomenon, an intraparenchymatous cerebrospinal fluid "lake" surrounding a ventricular catheter, was observed. Shunting recovery did not lead to a significant reduction in the phenomenon size. Causes underlying this phenomenon require further investigation.


Assuntos
Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Hidrocefalia/fisiopatologia , Hipertensão Intracraniana/cirurgia , Ventrículos Cerebrais/microbiologia , Ventrículos Cerebrais/fisiopatologia , Ventrículos Cerebrais/virologia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Criança , Citomegalovirus/isolamento & purificação , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/líquido cefalorraquidiano , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/microbiologia , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/microbiologia , Hidrocefalia/virologia , Hipertensão Intracraniana/fisiopatologia , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/virologia , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/patogenicidade
19.
Br J Neurosurg ; 30(4): 459-60, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26449688

RESUMO

We report a case of tumour-related hydrocephalus in a child treated with a ventriculo-peritoneal shunt which subsequently became infected with gram negative bacteria (Escherichia coli). After successful treatment of the infection the patient became shunt independent and has remained so for over 2 years. Gram negative ventriculitis is associated with diminished cerebro-spinal fluid production and we discuss the literature to date regarding this phenomenon.


Assuntos
Derivações do Líquido Cefalorraquidiano , Infecções por Escherichia coli/tratamento farmacológico , Hidrocefalia/microbiologia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal , Adolescente , Derivações do Líquido Cefalorraquidiano/métodos , Feminino , Humanos , Hidrocefalia/diagnóstico , Complicações Pós-Operatórias , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos
20.
Ugeskr Laeger ; 177(14): V12140655, 2015 Mar 30.
Artigo em Dinamarquês | MEDLINE | ID: mdl-25822950

RESUMO

Tuberculous meningitis (TBM) denotes infection of the meninges with Mycobacterium tuberculosis complex. In Denmark, TBM is rare, but requires correct handling and rapid treatment. We describe a case of TBM in a previously healthy 19-year-old man from Somalia, whose primary symptoms were fever, headache and altered mental state.


Assuntos
Hidrocefalia/microbiologia , Transtornos da Personalidade/microbiologia , Tuberculose Meníngea , Antituberculosos/uso terapêutico , Humanos , Hidrocefalia/diagnóstico por imagem , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Tomografia Computadorizada por Raios X , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Adulto Jovem
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