ABSTRACT
Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Calcitonin/blood , Calcitonin/cerebrospinal fluid , Central Nervous System Bacterial Infections/diagnosis , Craniotomy/adverse effects , APACHE , Biomarkers/blood , Biomarkers/cerebrospinal fluid , C-Reactive Protein/analysis , Central Nervous System Bacterial Infections/blood , Central Nervous System Bacterial Infections/cerebrospinal fluid , Central Nervous System Bacterial Infections/microbiology , Early Diagnosis , Leukocyte Count , Postoperative Complications/blood , Postoperative Complications/cerebrospinal fluid , Postoperative Complications/microbiology , Prognosis , Prospective Studies , Reference Values , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Time FactorsABSTRACT
Introducción: En la práctica clínica pediátrica no siempre resulta fácil la diferenciación entre las meningoencefalitis bacterianas y asépticas, lo cual genera encarecimiento del tratamiento en aquellos casos de meningoencefalitis asépticas, incremento del riesgo potencial de complicaciones, así como mayor impacto familiar. Método: Se realizó un estudio retrospectivo de los pacientes ingresados con el diagnóstico de meningoencefalitis en el Hospital Provincial Pediátrico Docente Eliseo Noel Caamaño, de la ciudad de Matanzas, durante un período de 5 años (377 pacientes), a quienes se les aplicó el score para meningoencefalitis bacteriana. Objetivo: Describir el puntaje al ingreso en los pacientes y clasificarlos en bajo o alto riesgo para meningoencefalitis bacteriana, así como compararlos con los diagnósticos al ingreso y egreso. Resultados: El 100 por ciento de los pacientes con meningoencefalitis bacteriana comprobadas bacteriológicamente mostraron puntaje de 2 o mayor (alto riesgo); también identificó 9 pacientes de bajo riesgo (puntaje de 0) para meningoencefalitis bacteriana, los cuales fueron considerados inicialmente como bacterianas y egresados como meningoencefalitis asépticas. Conclusión: El score para meningoencefalitis bacteriana pudiera ser una herramienta útil en la valoración inicial de los pacientes con síndrome neurológico infeccioso
In the clinical practice it is not always easy the differentiation between bacterial and aseptic meningoencephalitis, causing the raise of the treatment price in cases of aseptic meningoencephalitis, the increase of the potential risk of complications, and also a bigger familiar impact. We made a retrospective study of the patients admitted with the diagnosis of meningoencephalitis in the Infantile Hospital Eliseo Noel Caamaño during a 5-years period (377 patients), applying them the BMS (bacterial meningoencephalitis score). Our objective was describing the score at patients' admittance, and classifying them as presenting high or low risk for bacterial meningoencephalitis, and also comparing the diagnoses at the admittance and discharge. As a result, 100 percent of the patients with bacterial meningoencephalitis bacteriologically tested showed scores of 2 or higher (high risk); there were also identified 9 low risk patients (score 0 for bacterial meningoencephalitis), who were firstly considered as bacterial positive, and discharged as aseptic meningoencephalitis. The bacterial meningoencephalitis score could be a useful tool in the initial evaluation of the patients with the infectious Neurological Syndrome
Subject(s)
Humans , Adolescent , Infant , Child, Preschool , Child , Neurologic Examination/methods , Central Nervous System Bacterial Infections/diagnosis , Meningoencephalitis/diagnosis , Retrospective StudiesABSTRACT
Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83 percent) and fever (44 percent). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Brucellosis/diagnosis , Central Nervous System Bacterial Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Brucellosis/drug therapy , Central Nervous System Bacterial Infections/drug therapy , Magnetic Resonance Imaging , Prospective Studies , Tomography, X-Ray ComputedABSTRACT
La meningitis se define como la inflamación de las membranas que rodean al cerebro y a la médula espinal, que involucra la aracnoides, piamadre y el líquido cefalorraquídeo. Puede ocurrir a cualquier edad y es una emergencia, ya que si no se diagnostica precozmente y se indica tratamiento, puede ocasionar una mortalidad que varía del 2% al 30%, de acuerdo a la edad, o dejar secuelas permanentes tales como hidrocefalia, infarto cerebral, parálisis de pares craneales, alteraciones neuroendocrinas, colecciones intracraneales, hipertensión endocraneana, sordera neurosensorial, retraso psicomotor y parálisis cerebral. Se clasifica, de acuerdo a su tiempo de evolución en: aguda, crónica, recurrente; de acuerdo a su etiología en: infecciosas y no infecciosas. Las infecciosas pueden ser: virales, bacterianas, por hongos y por parásitos. Las no infecciosas pueden ser: tumorales, por enfermedades sistémicas y tóxicas. Los agentes infecciosos que invaden al Sistema Nervioso Central y causan meningitis, lo hacen a través de tres mecanismos: primero colonizan e infectan al huésped a través de la piel, nasofaringe, tracto respiratorio (la mayoría), genitourinario o gastrointestinal. Invaden la submucosa, vencen las barreras del huésped (física e inmunidad) y penetran al Sistema Nervioso Central por 3 vías: torrente sanguíneo, acceso retrógrado neuronal e inoculación directa, produciendo inflamación de las meninges
Meningitis is defined as the inflammation of the membranes that surround the brain and the spinal marrow, which involves the aracnoides, the pia mater and the spinal fluid. It can occur at any age, and it constitutes an emergency, since it may cause a mortality rate between 2 and 30 % or lead to permanent sequela as: brain edema, cerebral infarction, cranial nerve paralysis, neuroendocrine disorders, intracranial collections or hypertension, neurosensorial deafness, psychomotor delay, and cerebral palsy. According to the length of its evolution it is classified in acute, chronic and recurrent; according to its etiology, in infectious and non infectious. Infectious etiologies are viral, bacterial, fungic and parasitic. Non infectious etiologies are tumoral, toxic and systemic diseases. Infectious agents that invade the Central Nervous System (CNS) may cause meningitis by three mechanisms: first they colonize and infect the guest via skin, respiratory, genitourinary or gastrointestinal systems. They invade the submucosa, overcome the guests physical and immune barriers, and penetrate the CNS through 3 routes: blood, neuronal retrograde access and direct inoculation
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Encephalitis/pathology , Central Nervous System Bacterial Infections/diagnosis , Central Nervous System Bacterial Infections/pathology , Meningitis/complications , Meningitis/diagnosis , Central Nervous System/pathology , Pediatrics , Statistics on Sequelae and DisabilityABSTRACT
A 41 year old man presented to the outpatient department with a three month history of difficulty in walking. He also had a history of positive sensory symptoms in the form of pins and needle sensation mostly below the waist. His symptoms had been progressive and there was no significant family history. He demonstrated a spastic gait and could only walk with assistance and support. DTR were hypertonic and sensory deficit was observed below twelfth dorsal vertebra. Sphincter abnormalities were present. Plantars were extensor bilaterally. Cerebral and spinal MRI with contrast was unremarkable. Brucella antigen titers were significantly high. CSF report was consistent with neurobrucellosis. After detailed analysis of his history, clinical picture and investigations the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started, his neurologic condition gradually improved and he was able to walk without help after three months of treatment. Hence this case showed that neurobrucellosis may present as acquired progressive spastic paraparesis and it should always be borne in mind in patients with spastic paraparesis.
Subject(s)
Adult , Humans , Male , Brucellosis/complications , Central Nervous System Bacterial Infections/complications , Paraparesis, Spastic/etiology , Anti-Bacterial Agents/therapeutic use , Brucellosis/diagnosis , Brucellosis/drug therapy , Central Nervous System Bacterial Infections/diagnosis , Central Nervous System Bacterial Infections/drug therapy , Magnetic Resonance ImagingABSTRACT
INTRODUCCION: Listeria monocytogenes tiene una especial predilección por infectar el sistema nervioso central y sus cubiertas meningeas. Afecta a pacientes que se encuentran en edades extremas de la vida, pacientes con deficiencia en su inmunidad celular y adultos sanos. La forma mas común de manifestarse es la meningitis aguda, aunque puede expresarse como cerebritis, encefalitis de tronco (romboencefalitis), y excepcionalmente mielitis. CASUISTICA: Se presentan y comentan seis casos clinicos de neurolisteriosis, cinco en adultos sanos, con sus hallazgos imagenológicos y licuorales. RESULTADOS: Tres de los pacientes se presentaron como meningitis aguda, uno como meningoencefalitis, otro como cerebritis y el restante como romboencefalitis. Se destaca el carácter turbio o ligeramente turbio del líquido cefalo-raquideo (LCR), la glucorraquia normal detectada en tres de los casos y el diagnostico realizado en cinco de los casos por cultivo del LCR. Se comenta la resonancia magnética singular del caso de la romboencefalitis con microabscesos en tronco. Todos los pacientes tuvieron evolución satisfactoria con tratamiento antibiotico. CONCLUSION: La neurolisteriosis debe ser un diagnostico a tener en cuenta no solo en pacientes inmunocomprometidos o en edades extremas de la vida. Debe también tenerse en cuenta en pacientes adultos jóvenes sanos procedentes de regiones donde las condiciones sanitarias son precarias y no existe un adecuado control en la elaboración de alimentos.