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1.
Medicine (Baltimore) ; 98(25): e16079, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232949

RESUMO

Clinical signs and symptoms of central nervous system (CNS) infections in neonates are often nonspecific. Therefore, cerebrospinal fluid (CSF) analysis is performed to diagnose CNS infections. Data on combined microbiological results and their correlation with biochemical characteristics in CSF and blood in infants younger than 90 days are limited. This study provides an overview of microbiological test results, CSF- and hematological characteristics among infants with a clinically suspected CNS infection.This retrospective study included infants younger than 90 days, with a clinically suspected CNS infection who underwent a diagnostic lumbar puncture between January 2012 and January 2014. Data on the presence of microbiological pathogens in CSF, CSF inflammation markers (white blood cell [WBC] counts, protein levels and glucose CSF/serum ratio) and blood inflammatory responses (WBC count, C-reactive protein [CRP], neutrophil percentage) were collected by reviewing patient files.We included data from 576 infants (median age 12.5 days, interquartile range, 6-27 days) of whom 383 (66.5%) were born prematurely. In total, 16 bacterial pathogens (3.0%) and 21 viruses (5.5%) were detected in CSF. Escherichia coli was detected in 5 cases (1.0%), Enterovirus was detected in 12 cases (3.1%). Leucocytosis in CSF was associated with identification of a pathogen in CSF. Increased CRP was associated with the identification of a bacterial pathogen in CSF.Bacterial or viral pathogens were only identified in a small proportion of infants with a clinically suspected CNS infection. Leucocytosis in CSF was associated with CNS infection in infants. An increased CRP was indicative of bacterial meningitis.


Assuntos
Sangue/microbiologia , Infecções do Sistema Nervoso Central/sangue , Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Líquido Cefalorraquidiano/microbiologia , Infecções do Sistema Nervoso Central/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Estudos Retrospectivos , Estatísticas não Paramétricas
2.
N Engl J Med ; 380(24): 2327-2340, 2019 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-31189036

RESUMO

BACKGROUND: Metagenomic next-generation sequencing (NGS) of cerebrospinal fluid (CSF) has the potential to identify a broad range of pathogens in a single test. METHODS: In a 1-year, multicenter, prospective study, we investigated the usefulness of metagenomic NGS of CSF for the diagnosis of infectious meningitis and encephalitis in hospitalized patients. All positive tests for pathogens on metagenomic NGS were confirmed by orthogonal laboratory testing. Physician feedback was elicited by teleconferences with a clinical microbial sequencing board and by surveys. Clinical effect was evaluated by retrospective chart review. RESULTS: We enrolled 204 pediatric and adult patients at eight hospitals. Patients were severely ill: 48.5% had been admitted to the intensive care unit, and the 30-day mortality among all study patients was 11.3%. A total of 58 infections of the nervous system were diagnosed in 57 patients (27.9%). Among these 58 infections, metagenomic NGS identified 13 (22%) that were not identified by clinical testing at the source hospital. Among the remaining 45 infections (78%), metagenomic NGS made concurrent diagnoses in 19. Of the 26 infections not identified by metagenomic NGS, 11 were diagnosed by serologic testing only, 7 were diagnosed from tissue samples other than CSF, and 8 were negative on metagenomic NGS owing to low titers of pathogens in CSF. A total of 8 of 13 diagnoses made solely by metagenomic NGS had a likely clinical effect, with 7 of 13 guiding treatment. CONCLUSIONS: Routine microbiologic testing is often insufficient to detect all neuroinvasive pathogens. In this study, metagenomic NGS of CSF obtained from patients with meningitis or encephalitis improved diagnosis of neurologic infections and provided actionable information in some cases. (Funded by the National Institutes of Health and others; PDAID ClinicalTrials.gov number, NCT02910037.).


Assuntos
Líquido Cefalorraquidiano/microbiologia , Encefalite/microbiologia , Genoma Microbiano , Meningite/microbiologia , Metagenômica , Adolescente , Adulto , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , Encefalite/diagnóstico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Infecção/diagnóstico , Tempo de Internação , Masculino , Meningite/diagnóstico , Meningoencefalite/diagnóstico , Meningoencefalite/microbiologia , Pessoa de Meia-Idade , Mielite/diagnóstico , Mielite/microbiologia , Estudos Prospectivos , Análise de Sequência de DNA , Análise de Sequência de RNA , Adulto Jovem
3.
BMC Infect Dis ; 19(1): 560, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242869

RESUMO

BACKGROUND: Acute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae in children. To determine the etiology of childhood AMES in Shenzhen, a hospital-based study was undertaken. METHODS: A total of 240 cerebrospinal fluid (CSF) samples from 171 children meeting the case definition were included and screened for 12 common causative organisms. The clinical data and conventional testing results were collected and analyzed. Whole genome sequencing was performed on a Neisseria meningitidis isolate. RESULTS: A pathogen was found in 85 (49.7%) cases; Group B Streptococcus (GBS) was detected in 17 cases, Escherichia coli in 15, Streptococcus pneumoniae in 14, enterovirus (EV) in 13, herpes simplex virus (HSV) in 3, N. meningitidis in 1, Haemophilus influenzae in 1, and others in 23. Notably, HSV was found after 43 days of treatment. Twelve GBS and 6 E. coli meningitis were found in neonates aged less than 1 month; 13 pneumococcal meningitis in children aged > 3 months; and 12 EV infections in children aged > 1 year old. The multilocus sequence typing of serogroup B N. meningitidis isolate was ST-3200/CC4821. High resistance rate to tetracycline (75%), penicillin (75%), and trimethoprim/sulfamethoxazole (75%) was found in 4 of S. pneumoniae isolates; clindamycin (100%) and tetracycline (100%) in 9 of GBS; and ampicillin (75%) and trimethoprim/sulfamethoxazole (67%) in 12 of E. coli. CONCLUSIONS: The prevalence of N. meningitidis and JEV was very low and the cases of childhood AMES were mainly caused by other pathogens. GBS and E. coli were the main causative organisms in neonates, while S. pneumoniae and EV were mainly found in older children. HSV could be persistently found in the CSF samples despite of the treatment. A better prevention strategy for GBS, the introduction of pneumococcal vaccine, and incorporation of PCR methods were recommended.


Assuntos
Encefalite/epidemiologia , Encefalite/etiologia , Hospitais Pediátricos , Meningite/epidemiologia , Meningite/etiologia , Vigilância de Evento Sentinela , Doença Aguda , Técnicas de Tipagem Bacteriana/métodos , Líquido Cefalorraquidiano/microbiologia , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , China/epidemiologia , Encefalite/líquido cefalorraquidiano , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/líquido cefalorraquidiano , Reação em Cadeia da Polimerase/métodos , Prevalência , Índice de Gravidade de Doença , Síndrome , Virologia/métodos
4.
Nat Commun ; 10(1): 1667, 2019 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-30971685

RESUMO

Neutrophils are crucial mediators of host defense that are recruited to the central nervous system (CNS) in large numbers during acute bacterial meningitis caused by Streptococcus pneumoniae. Neutrophils release neutrophil extracellular traps (NETs) during infections to trap and kill bacteria. Intact NETs are fibrous structures composed of decondensed DNA and neutrophil-derived antimicrobial proteins. Here we show NETs in the cerebrospinal fluid (CSF) of patients with pneumococcal meningitis, and their absence in other forms of meningitis with neutrophil influx into the CSF caused by viruses, Borrelia and subarachnoid hemorrhage. In a rat model of meningitis, a clinical strain of pneumococci induced NET formation in the CSF. Disrupting NETs using DNase I significantly reduces bacterial load, demonstrating that NETs contribute to pneumococcal meningitis pathogenesis in vivo. We conclude that NETs in the CNS reduce bacterial clearance and degrading NETs using DNase I may have significant therapeutic implications.


Assuntos
Líquido Cefalorraquidiano/citologia , Armadilhas Extracelulares/microbiologia , Evasão da Resposta Imune , Meningite Pneumocócica/imunologia , Neutrófilos/imunologia , Streptococcus pneumoniae/imunologia , Adolescente , Adulto , Idoso , Animais , Grupo Borrelia Burgdorferi/imunologia , Encéfalo/citologia , Encéfalo/efeitos dos fármacos , Encéfalo/imunologia , Encéfalo/microbiologia , Líquido Cefalorraquidiano/imunologia , Líquido Cefalorraquidiano/microbiologia , Desoxirribonuclease I/administração & dosagem , Modelos Animais de Doenças , Armadilhas Extracelulares/efeitos dos fármacos , Armadilhas Extracelulares/imunologia , Feminino , Humanos , Neuroborreliose de Lyme/líquido cefalorraquidiano , Neuroborreliose de Lyme/imunologia , Neuroborreliose de Lyme/microbiologia , Masculino , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/tratamento farmacológico , Meningite Pneumocócica/microbiologia , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/imunologia , Pessoa de Meia-Idade , Neutrófilos/microbiologia , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/administração & dosagem , Punção Espinal , Streptococcus pneumoniae/isolamento & purificação , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 289, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922257

RESUMO

BACKGROUND: Purulent meningitis (PM) is a serious life-threatening infection of the central nervous system (CNS) by bacteria or fungi and associated with high mortality and high incidence of CNS sequelae in children. However, the conventional cerebrospinal fluid (CSF) culture method is time-consuming and has a low sensitivity. METHODS: Our study developed a real-time PCR-based purulent meningitis-TaqMan array card (PM-TAC) that targeted 21 PM-related pathogens and could produce results within 3 h. Primers and probes were adapted from published sources possibly. The performance of them were evaluated and optimized and then they were spotted on TAC. RESULTS: The PM-TAC showed a sensitivity and specificity of 95 and 96%, respectively. For all of the 21 targeted pathogens, the PM-TAC assay had a LOD ranging from 5 copies/reaction to 100 copies/reaction, an intra-assay variation of 0.07-4.45%, and an inter-assay variation of 0.11-6.81%. Of the 15 CSF samples collected from patients with PM after empiric antibiotic therapies, the positive rate was 53.3% (8/15) for our PM-TAC assay but was only 13.3% (2/15) for the CSF culture method. Of the 17 CSF samples showing negative CSF culture, the PM-TAC assay identified a case of Neisseria meningitidis infection. Furthermore, all of the 10 CSF samples from patients without CNS infection showed negative for the PM-TAC assay. CONCLUSIONS: Our PM-TAC assay also demonstrated that the pathogen loads in the CSF samples correlated with the severity of PM. Thus, the PM-TAC may be helpful to improve the prognosis of PM and clinical outcomes from antibiotic therapies.


Assuntos
Bactérias/genética , Fungos/genética , Meningites Bacterianas/microbiologia , Meningite Fúngica/microbiologia , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Bactérias/classificação , Bactérias/isolamento & purificação , Bactérias/patogenicidade , Líquido Cefalorraquidiano/microbiologia , Criança , Primers do DNA/genética , Feminino , Fungos/isolamento & purificação , Fungos/patogenicidade , Humanos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningite Fúngica/líquido cefalorraquidiano , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Sensibilidade e Especificidade
6.
BMC Infect Dis ; 19(1): 220, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832607

RESUMO

BACKGROUND: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/µL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. CASE PRESENTATION: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/µL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. CONCLUSIONS: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/µL.


Assuntos
Medula Óssea/microbiologia , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Infecções por HIV/patologia , Lesão Renal Aguda/etiologia , Anfotericina B/efeitos adversos , Anfotericina B/farmacologia , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Medula Óssea/patologia , Linfócitos T CD4-Positivos/citologia , Líquido Cefalorraquidiano/microbiologia , Criptococose/complicações , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Cryptococcus neoformans/efeitos dos fármacos , Cryptococcus neoformans/genética , Ácido Desoxicólico/efeitos adversos , Ácido Desoxicólico/farmacologia , Ácido Desoxicólico/uso terapêutico , Diagnóstico Diferencial , Combinação de Medicamentos , Fluconazol/farmacologia , Fluconazol/uso terapêutico , Genótipo , Infecções por HIV/complicações , Humanos , Masculino , Meningite/complicações , Meningite/diagnóstico , Pessoa de Meia-Idade
7.
Rinsho Shinkeigaku ; 59(3): 133-138, 2019 Mar 28.
Artigo em Japonês | MEDLINE | ID: mdl-30814444

RESUMO

A 68-year-old man visited our hospital emergency department with consciousness disturbance. He was diagnosed as bacterial meningitis with septic shock, and initial empirical antibacterial therapy was initiated immediately. Streptococcus pneumoniae. was cultured from the cerebrospinal fluid (CSF), and brain MRIs showed pyogenic ventriculitis. Even though CSF findings improved, he was still in coma and finally died with pneumonia. It is unknown how pyogenic ventriculitis affects the course of bacterial meningitis. We analyzed total 11 inpatients with bacterial meningitis associated with or without the pyogenic ventriculitis, including the present patient, in our hospital. Severity of clinical symptoms and CSF findings might determine the duration of antimicrobial administration, regardless of whether pyogenic ventriculitis existed or not.


Assuntos
Antibacterianos/administração & dosagem , Ventriculite Cerebral/complicações , Meningite Pneumocócica/complicações , Meningite Pneumocócica/tratamento farmacológico , Idoso , Encéfalo/diagnóstico por imagem , Ventriculite Cerebral/diagnóstico por imagem , Líquido Cefalorraquidiano/microbiologia , Quimioterapia Combinada , Evolução Fatal , Humanos , Imagem por Ressonância Magnética , Masculino , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/microbiologia , Índice de Gravidade de Doença , Streptococcus pneumoniae/isolamento & purificação , Supuração
8.
Anaerobe ; 56: 95-97, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772448

RESUMO

We have reported a case of mastoiditis which progressed to meningitis in a 16-year old male patient. CSF (cerebrospinal fluid) anaerobic culture revealed four species of isolated anaerobic bacteria. This is the first case in the literature in which a patient survived childhood polymicrobial anaerobic meningitis diagnosed by MALDI-TOF MS (Matrix Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry).


Assuntos
Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/isolamento & purificação , Coinfecção/diagnóstico , Coinfecção/patologia , Mastoidite/complicações , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/patologia , Adolescente , Técnicas Bacteriológicas , Líquido Cefalorraquidiano/microbiologia , Coinfecção/microbiologia , Humanos , Masculino , Meningites Bacterianas/microbiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
10.
J Clin Lab Anal ; 33(3): e22707, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30666716

RESUMO

BACKGROUND: Meningitis and encephalitis (ME) are central nervous system (CNS) infections mainly caused by bacteria, mycobacteria, fungi, viruses, and parasites that result in high morbidity and mortality. The early, accurate diagnosis of pathogens in the cerebrospinal fluid (CSF) and timely medication are associated with better prognosis. Conventional methods, such as culture, microscopic examination, serological detection, CSF routine analysis, and radiological findings, either are time-consuming or lack sensitivity and specificity. METHODS: To address these clinical needs, we developed an advanced fragment analysis (AFA)-based assay for the multiplex detection of 22 common ME pathogens, including eight viruses, 11 bacteria, and three fungi. The detection sensitivity of each target was evaluated with a recombinant plasmid. The limits of detection of the 22 pathogens ranged from 15 to 120 copies/reaction. We performed a retrospective study to analyze the pathogens from the CSF specimens of 170 clinically diagnosed ME patients using an AFA-based assay and compared the results with culture (bacteria and fungi), microscopic examination (fungi), polymerase chain reaction (PCR) (Mycobacterium tuberculosis), and Sanger sequencing (virus) results. RESULTS: The sensitivity of the AFA assay was 100% for 10 analytes. For Cryptococcus neoformans, the sensitivity was 63.6%. The overall specificity was 98.2%. The turnaround time was reduced to 4-6 hours from the 3-7 days required using conventional methods. CONCLUSIONS: In conclusion, the AFA-based assay provides a rapid, sensitive, and accurate method for pathogen detection from CSF samples.


Assuntos
Líquido Cefalorraquidiano/microbiologia , Encefalite/microbiologia , Meningite/microbiologia , Tipagem Molecular/métodos , Adolescente , Adulto , Criança , Pré-Escolar , DNA Bacteriano/líquido cefalorraquidiano , DNA Fúngico/líquido cefalorraquidiano , Encefalite/diagnóstico , Feminino , Humanos , Limite de Detecção , Masculino , Meningite/diagnóstico , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
11.
Mycoses ; 62(3): 252-260, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30565742

RESUMO

Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI complications in haematologic patients.


Assuntos
Antifúngicos/uso terapêutico , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Desbridamento , Fungos/classificação , Fungos/isolamento & purificação , Neoplasias Hematológicas/complicações , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/terapia , Líquido Cefalorraquidiano/microbiologia , Criança , Pré-Escolar , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/microbiologia , Sinusite/microbiologia , Sinusite/terapia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
12.
Microsc Res Tech ; 82(2): 122-127, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30575195

RESUMO

Drug-resistant tuberculosis is being increasingly recognized and is one among the leading cause of death worldwide. Remarkable impermeability of cell wall to antituberculous drugs protects the mycobacteria from drug action. The present study analyzed the cell wall thickness among first-line drug resistant and sensitive Mycobacterium tuberculosis (Mtb) isolated from cerebrospinal fluid by transmission electron microscopy (TEM). The average thickness of the cell wall of sensitive isolates was 13.60 ± 0.98 nm. The maximum difference (26.48%) in the cell wall thickness was seen among multi-drug resistant (18.50 ± 1.71 nm) isolates and the least difference (4.14%) was shown by streptomycin-resistant (14.18 ± 1.38 nm) isolates. The ultrastructural study showed evident differences in the cell wall thickness among sensitive and resistant isolates. Preliminary TEM examination of cells indicates that morphological changes occur in the cell wall which might be attributed to the drug resistance. The thickened wall of Mtb appears to help the bacilli to overcome the action of antituberculous drugs.


Assuntos
Parede Celular/ultraestrutura , Farmacorresistência Bacteriana , Mycobacterium tuberculosis/ultraestrutura , Antituberculosos/farmacologia , Biometria , Líquido Cefalorraquidiano/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Microscopia Eletrônica de Transmissão , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Meníngea/microbiologia
13.
Int J Infect Dis ; 79: 104-108, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30529369

RESUMO

OBJECTIVE: The aim of this study was to investigate the occurrence of paradoxical reaction (PR) in HIV-negative tuberculous meningitis (TBM) patients with spinal involvement, as well as its possible risk factors. METHODS: Fifty TBM patients with spinal involvement were studied retrospectively and divided into a PR group and a non-PR group according to the presence of PR. Their demographic, clinical, radiological, and laboratory data, and status at follow-up were collected and compared. RESULTS: PR developed in 26 patients (52%), with the median time to the development of PR being 30days (range 15-330 days) after the initiation of tuberculosis therapy. At initial diagnosis, age, documented acid-fast bacilli (AFB), and the cerebrospinal fluid protein level were found to differ significantly between the two groups. After multivariate analysis, age, documented AFB, and vertebral involvement were significantly associated with the development of PR. CONCLUSIONS: PR was common in TBM patients with spinal involvement. Age, documented AFB, and musculoskeletal involvement may be predictors of PR development.


Assuntos
Medula Espinal/microbiologia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/terapia , Adulto , Bacillus/isolamento & purificação , Líquido Cefalorraquidiano/microbiologia , Proteínas do Líquido Cefalorraquidiano , Feminino , Seguimentos , Infecções por HIV , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
BMJ Case Rep ; 11(1)2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580292

RESUMO

A 49-year-old Caucasian woman presented with subacute headache and right eye pain associated with scotoma, blurred vision and photophobia. MRI was suggestive of optic neuritis of the right optic nerve and she was treated with steroids. Due to persistent symptoms, a lumbar puncture was performed and cerebrospinal fluid analysis was positive for venereal disease research laboratory and rapid plasma reagin titres. On further history, she recalled experiencing an illness associated with diffuse rash, likely secondary syphilis, 1-2 months prior. She tested negative for HIV. She was treated with intravenous penicillin for 2 weeks following which she experienced improvement in symptoms.


Assuntos
Dor Ocular/microbiologia , Cefaleia/microbiologia , Neurite Óptica/microbiologia , Escotoma/microbiologia , Sífilis/complicações , Doença Aguda , Líquido Cefalorraquidiano/microbiologia , Dor Ocular/líquido cefalorraquidiano , Dor Ocular/diagnóstico , Feminino , Cefaleia/líquido cefalorraquidiano , Cefaleia/diagnóstico , Humanos , Pessoa de Meia-Idade , Neurite Óptica/líquido cefalorraquidiano , Neurite Óptica/diagnóstico , Escotoma/líquido cefalorraquidiano , Escotoma/diagnóstico , Punção Espinal , Sífilis/líquido cefalorraquidiano
15.
Medicine (Baltimore) ; 97(29): e11186, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30024502

RESUMO

RATIONALE: Tuberculous meningitis is a highly morbid, often fatal disease. PATIENT CONCERN: We describe a case of an Italian child. DIAGNOSES:: we diagnosed early a Tuberculous meningitis complicated by the occurrence of hydrocephalus, stroke, and paradoxical reaction with brain pseudo-abscesses. INTERVENTIONS: The child started readily a specific therapy associated with steroids and thalidomide was introduced few month later. OUTCOMES: the patient had a favorable outcome without neurologic sequelae. LESSONS: Despite the prompt specific anti-tubercular and adjuvant corticosteroid therapies, only the addition of thalidomide to the treatment allow to a favorable clinical outcome.


Assuntos
Antituberculosos/uso terapêutico , Imunossupressores/uso terapêutico , Talidomida/uso terapêutico , Tuberculose Meníngea/tratamento farmacológico , Encéfalo/patologia , Líquido Cefalorraquidiano/microbiologia , Criança , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidrocefalia/etiologia , Imunocompetência , Itália , Imagem por Ressonância Magnética , Mycobacterium tuberculosis/isolamento & purificação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Tuberculose Meníngea/complicações
17.
Medicine (Baltimore) ; 97(30): e11561, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30045281

RESUMO

RATIONALE: Mild encephalitis/encephalopathy with a reversible splenial lesion is a clinico-radiological syndrome mainly triggered by viral infection. Bacteria, like listeria monocytogenes, are relatively rare pathogens. PATIENT CONCERNS: A two and a half years old girl with a 3-day history of fever and vomiting, complicated by a sudden seizure. She was in a coma after seizure. DIAGNOSES: Listeria monocytogenes was detected in cerebrospinal fluid cultures. Serum IL-6 remarkably elevated, and hyponatremia appeared on day 2 of hospitalization. Magnetic resonance imaging of the brain performed on day 3 of hospitalization showed right subdural effusion and a lesion in the central portion of the splenium of the corpus callosum. INTERVENTIONS: We administered antimicrobial therapy, intravenous mannitol and hypertonic fluid therapy. OUTCOMES: Her neurological symptoms improved gradually. The lesion in the splenium of the corpus callosum completely disappeared on magnetic resonance imaging on day 10 of hospitalization. LESSONS: We diagnosed this case as mild encephalitis/encephalopathy with a reversible splenial lesion caused by listeria monocytogenes. The patient recovered completely clinically and on imaging, without any specific immunomodulatory treatment. It also indicated IL-6 may play a role in the forms of hyponatremia in mild encephalitis/encephalopathy with a reversible splenial lesion.


Assuntos
Antibacterianos/administração & dosagem , Encefalopatias , Corpo Caloso , Soluções Hipertônicas/administração & dosagem , Listeria monocytogenes , Manitol/administração & dosagem , Meningite por Listeria , Encefalopatias/sangue , Encefalopatias/diagnóstico , Encefalopatias/etiologia , Encefalopatias/terapia , Líquido Cefalorraquidiano/microbiologia , Pré-Escolar , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Diuréticos Osmóticos , Monitoramento de Medicamentos , Feminino , Humanos , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hiponatremia/etiologia , Listeria monocytogenes/efeitos dos fármacos , Listeria monocytogenes/isolamento & purificação , Imagem por Ressonância Magnética/métodos , Meningite por Listeria/sangue , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Meningite por Listeria/fisiopatologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 97(24): e11110, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29901631

RESUMO

RATIONALE: Neurological melioidosis, an extremely rare condition, is caused by the gram-negative bacterium Burkholderia pseudomallei. If treatment is suboptimal or delayed, this infection can produce diverse clinical symptoms and result in death. PATIENT CONCERNS: A healthy 65-year-old female who had been treated with antipsychotic medication for neurotic depression for over 2 years presented with acute-onset fever, headache, lead-pipe rigidity of all limbs, and delirium. DIAGNOSES: Melioidosis meningitis was diagnosed by performing blood examinations and cerebrospinal fluid analysis and cultures. INTERVENTIONS: Intravenous ceftazidime (2 g/8 h for 3 weeks) was administered in-hospital and 240 mg trimethoprim/1200 mg sulfamethoxazole and 100 mg minocycline twice daily administered out-hospital. OUTCOMES: The patient fully recovered after antibiotic therapy without cognitive deficits and associated neurological complications. LESSONS: Because melioidosis is endemic in Southern Taiwan and the use of antipsychotics might mask the symptoms, physicians dealing with patients from endemic areas with a medical history of antipsychotics should always consider the possibility of neurological melioidosis and provide prompt empirical management to suspicious cases.


Assuntos
Antibacterianos/uso terapêutico , Antipsicóticos/efeitos adversos , Burkholderia pseudomallei/isolamento & purificação , Melioidose/diagnóstico , Meningites Bacterianas/diagnóstico , Idoso , Antipsicóticos/uso terapêutico , Ceftazidima/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Transtorno Depressivo/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Melioidose/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Minociclina/uso terapêutico , Síndrome Maligna Neuroléptica/diagnóstico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
19.
Medicine (Baltimore) ; 97(24): e11156, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29901648

RESUMO

RATIONALE: Purulent meningitis refers infection of the subarachnoid space by various purulent bacteria and the corresponding inflammation of the leptomeninges. However, purulent meningitis due to Rhodococcus equi is extremely rare. PATIENT CONCERNS: A 40-year-old man presented with fever and intermittent headache for 6 days. Two hours prior to admission, he developed epileptic seizures. DIAGNOSES: Brain computed tomography and magnetic resonance imaging showed intracerebral malacic lesions. Bacterial culture of cerebrospinal fluid revealed the presence of R. equi. A diagnosis of purulent meningitis caused by R. equi was made. INTERVENTIONS: The patient was treated with intravenous meropenem (1000 mg every 8 hours) for 19 days; then he was discharged and instructed to continue the intravenous meropenem for two weeks. After a follow-up period of 2 months, the patient had recovered completely. OUTCOMES: After a follow-up period of 2 months, the patient had recovered completely. LESSONS: Central nervous system infection caused by R. equi is rare. Early bacterial culture of CSF is important for timely diagnosis. With sufficient antibiotic therapy, the prognosis can be favorable.


Assuntos
Infecções por Actinomycetales/diagnóstico , Meningites Bacterianas/diagnóstico , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Humanos , Masculino , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Meropeném , Tienamicinas/uso terapêutico
20.
Am J Case Rep ; 19: 599-603, 2018 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-29795055

RESUMO

BACKGROUND Tuberculoma and neurocysticercosis (NCC) often show similar clinical and neuroimaging features. Differential diagnosis of these 2 diseases is imperative, as tuberculoma is an active infection that requires immediate anti-tubercular therapy (ATT). CASE REPORT We present the case of a 17-year-old Indian girl with fever, severe headache, and right 6th cranial nerve palsy. Brain magnetic resonance imaging (MRI) showed multiple tiny ring-enhancing lesions in bilateral cerebral parenchyma with mild perilesional edema, which were initially thought to be NCC, but subsequently were diagnosed as brain tuberculomas. Based on clinical findings, mildly increased choline/creatine ratio (1.35) with slight prominent lipid lactate peak and absence of alanine, succinate peak by magnetic resonance spectroscopy (MRS), and the detection of Mycobacterium tuberculosis (Mtb)-specific early-secreted antigenic target-6 (ESAT-6, Rv3875) protein from the cerebrospinal fluid (CSF) by indirect ELISA, as well as indirect immuno-PCR (I-PCR) assay, diagnosis of brain tuberculomas associated with tuberculous meningitis (TBM) was confirmed, which was followed by ATT. The patient responded well and the symptoms resolved. CONCLUSIONS In this case, multiple ring-enhancing lesions of the brain by MRI were diagnosed as tuberculomas associated with TBM by MRS and indirect ELISA/I-PCR method, thus resolving the diagnostic dilemma.


Assuntos
Erros de Diagnóstico , Neurocisticercose/diagnóstico , Reação em Cadeia da Polimerase/métodos , Tuberculoma Intracraniano/diagnóstico , Tuberculose Meníngea/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Encéfalo/diagnóstico por imagem , Líquido Cefalorraquidiano/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Mycobacterium tuberculosis/isolamento & purificação , Neurocisticercose/diagnóstico por imagem , Neurocisticercose/terapia , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose Meníngea/diagnóstico por imagem
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