[Prognostic factors in adults with community-acquired bacterial meningitis in intensive care unit]

Bacterial meningitis is a serious disease with a high mortality. The severe forms need an early management at the intensive care unit. We report a retrospective study over 14 years [1992- 2006] in medical intensive care unit. We studied demographic clinics, biologic, therapeutic variables, and the outcomes in patients aged > 16 years and presented with community-acquired bacterial. The variables were compared between surviving and died group. Statistic: t test, Chi2, regression logistic. 201 patients were included. [139 men/ 62 women, age: 35 +/- 16 years SAPSII: 6,4 +/- 4,5]. 51 episodes of bacterial meningitis presented with altered mental status [Glasgow coma scale [GCS] was: 12 +/- 3]. Overall mortality rate was 19, 9%. On unvaried analysis, the factors associated with mortality were: age over 60 years, presence of a clinical symptoms > 72 hours before hospitalisation, GCS of 10 or less, visceral failure, lack of neck stiffness, heart rate >100 b/min, a high respiratory frequency, mean arterial blood pressure < 90 mm Hg, APACHE II score more than 12 during the 24 hours of admission, blood glucose level > 1,8 g/l and CSF glucose levels lower than 0,4 g/l. in the multivariate model seven conditions were significantly associated with mortality: age over 40 years [Odds Ratio [OR] = 4,7 ; IC 95%: 1,6 +/- 13,6], presence of symptoms >3days before admission [OR = 2,5: IC 95%: 3,2 +/- 47,8], low score of GCS[OR = 4,1: IC 95%: 1,4 +/- 11,6], respiratory rate> 30 cycles /min [OR = 7,3: IC 95%: 1,7 CSF +/- 32,3], presence of shock chock [OR = 19,8 ; IC 95%: 4,1 +/- 96], blood glucose level > 2 g/l [OR = 5,1: IC95%: 1,5 +/- 17,2] and CSF glucose level < 0,4 gl [OR = 5,1 ; IC 95%: 1,8 +/- 17,8]. Advanced age, delay of hospitalisation, severity of the disease at admission and hypoglucorrachia are the major prognosis factors of mortality intensive care unit

[Iodinated contrast induced acute renal and meningo-encephalitis]

The aim of this work is to report the cases of iatrogenic acute renal failure which has occurred after emergency realization of a cerebral scanner, with injection of iodinated contrast product at patients contracted by the meningoencephalitis. This prospective work was realized in a medical intensive care unit between January 2002 and December 2008. The criterion of principal judgment was the creatinin rate variations [>25% of its basic value] in the three weeks after a cerebral scanner with injection of iodinated contrast product at patients contracted by the meningoencephalitis. Eight patients were included among 360 meningoencephalitis cases corresponding to an incidence of 2.2%. The middle age was 43 +/- 17 years. The average time of appearance of the acute renal failure was 43 +/- 17 hours, with an average creatininemia of 66,8 +/- 37 mg/l. Three patients died. The incidence of this undesirable event remains weak but deserves a special attention. An adequate rehydration, before all using of the cerebral scanner with injection, should be realized for any patient presenting a meningoencephalitis

[Steroids for treating tuberculous meningite meningitis]

Tuberculous meningitis is a common form of central nervous system infections in many developing countries where tuberculosis is highly endemic. It constitutes the most grave form of mycobacterium tuberclosis infection. Despite anti-tuberculosus treatment, death or severe neurological disability occur in more than 50% of patients. To improve the prognosis of this disease, steroids were used as an adjuvant treatment for several decades. Its effect have remained controversial until recently there are more evidence of its effectiveness in terms of mortality and neurological sequelae among survivors. This paper is a synthesis of various studies on the effects of steroids in tuberculous meningitis

Prevalence of antitiuberculous drug-induced cytolytic hepatitis of tuberculous meningitises

The aim of this work was to specify the prevalence and the description of scondary cytolytic hepatitis of the antituberculous drugs used in treatment of tuberculous meningitis in the intensive care units. Method: We have been included retro-spectively [January 1998 - December 2002] patients having a tuberculous meningitis treated with antituberculous drugs who developed a cytolytic hepatitis defined by an increase of the alanin-aminotransferase [ALAT] level more than two times of its normal upper limit. Six cases have been included among 74 patients [prevalence of 8,1%], three women and three men aged 17 to 45 years. The delay of apparition of cytolytic hepatitis varied from four days to five weeks. ALAT rates varied from two and half to 26 times the normal level. No other potentialy hepatotoxic medication has been prescribed. Three patients normalized their ALAT after reducing the rifam picin dose to half measure, in another case a definitive stoppage of isoniazid was required. Ytolytic hepatitis regressed spotaneously in one patient whereas another died as a result of a nosocomial infection. The prevalence of secondary cytolytic hepatitis of antituberculous drugs during treatment of tuberculous meningitis in the intensive care unit raised to 8,1%, the evolution is most often favourable after adaptation of doses