Meningitis tras técnica combinada raquídea-epidural para analgesia del parto: reporte de un caso / Case report of meningitis after combined spinal-epidural analgesia for labor

La meningitis pospunción es una complicación importante y poco frecuente de la anestesia neuroaxial. Describimos el caso de una paciente que ingresa para inducción del parto. Se realiza técnica espinal-epidural para analgesia del parto. Cursando 48 h de puerperio instala cefalea intensa, fotofobia y fiebre. No focalidad neurológica. Sin rigidez de nuca. Al examen, restos cavitarios que impresionan fétidos. Se plantea endometritis puerperal iniciando tratamiento antibiótico. Dado la persistencia del cuadro clínico se plantea punción lumbar para confirmación diagnóstica mediante análisis de líquido cefalorraquídeo; siendo éste turbio, por lo cual ingresa a cuidados intensivos con diagnóstico de meningitis aguda. Bacterióloga informa a los 10 días que el cultivo desarrolla estreptococo mitis oralis. La importancia esta dada porque la meningitis puede ser potencialmente devastadora si no se realiza un diagnóstico y tratamiento tempranos, existiendo medidas que se pueden adoptar para prevenir esta complicación.

Post-puncture meningitis is an important and rare complication of neuraxial anesthesia. We describe case of patient who is admitted for induction of labor. A spinal-epidural technique is performed for labor analgesia. During 48 hours of puerperium, she installed intense headache, photophobia and fever. No neurological focus. No stiff neck. On physical exam, cavitary remains that appear fetid. Puerperal endometritis arises starting antibiotic treatment. Given the persistence of the clinical picture, lumbar puncture is considered for diagnostic confirmation by analysis of cerebrospinal fluid; This being cloudy, for which he was admitted to Intensive Care with a diagnosis of acute meningitis. Bacteriologist reports 10 days later develops streptococcus mitis oralis. The importance is given because meningitis can be potentially devastating if early diagnosis and treatment is not performed, and there are measures that can be taken to prevent this complication.

Meningite na infância: uma análise das internações hospitalares no Brasil / Meningitis in childhood: an analysis of hospital hospitalizations in Brazil

Objetivo: Analisar o perfil epidemiológico da meningite em crianças no Brasil. Método: Trata-se de estudo descritivo, cujos dados foram obtidos através de análise documental do Departamento de Informática do Sistema Único de Saúde (DATASUS) por meio de dados disponibilizados pela notificação no Sistema de Informação e Agravos de Notificação (Sinan). Foram utilizados dados da notificação de meningite no período de 2008 a 2019, em crianças até os 14 anos de idade no país. Resultados: Na faixa etária pediátrica, foram notificados 127.508 casos, o equivalente a 55,83% de todos os diagnósticos realizados neste período em todas as faixas etárias. Na amostra, houve maior prevalência da faixa etária entre 1 ano a 4 anos. Em relação ao sexo, o masculino foi o mais prevalente. Quanto à evolução dos casos notificados, a maioria dos pacientes tiveram alta hospitalar. Destes, a faixa etária entre 1 a 4 anos obteve maior prevalência. Quanto aos óbitos por meningite, houve maior prevalência da faixa etária de menores de 1 ano. O método quimiocitológico foi o método diagnóstico mais utilizado, evidenciando principalmente a meningite de etiologia viral. Conclusão: Verifica-se que os casos de meningite são prevalentes na faixa etária pediátrica, havendo predomínio da faixa etária entre 1 a 4 anos e do sexo masculino neste estudo. Ressalta-se a importância de ações preventivas, como a imunização vacinal, sobretudo quando se percebe a maior letalidade da meningite bacteriana

Primary cerebrospinal fluid leak complicated with meningitis and parainfectious vasculitis: case report and literature review / Fístula liquórica primária complicada com meningite e vasculite parainfecciosa: relato de caso e revisão de literatura

This paper aims to describe a case of an immunocompetent 60-year-old patient presenting a subarachnoid hemorrhage in the absence of aneurysmal disease. Initial evaluation pointed to vasculitis of the central nervous system secondary to meningeal infection. After initial treatment, a cerebrospinal fluid leak was identified, with no antecedent of trauma, elucidating the origin of infection. Primary cerebrospinal fluid rhinorrhea has nonspecific symptomatology, defying diagnosis, and potentially serious complications. It represents an unusual predisposing factor for meningeal infection and secondary vasculitis. This case report exemplifies a feared complication of spontaneous cerebrospinal fluid leakage.

O estudo objetiva relatar um caso clínico de uma paciente imunocompetente de 60 anos apresentando hemorragia subaracnoide na ausência de doença aneurismática. Avaliação inicial apontou para vasculite de sistema nervoso central secundária à infecção meníngea. Após tratamento inicial, uma fístula liquórica foi identificada, sem antecedente de trauma, elucidando a origem da infecção. Rinorreia liquórica primária possui sintomatologia inespecífica, diagnóstico desafiador e complicações potencialmente graves. Representa um raro fator predisponente para infecção meníngea e vasculite. Este relato de caso exemplifica uma complicação temida da rinorreia liquórica espontânea.

Paquimeningitis hipertrófica en vasculitis anca positivo: reporte de caso y revisión de la literatura / Hypertrophic pachymeningitis in positive ANCA vasculitis: case report and literature review

La paquimeningitis hipertrófica (PH), es una manifestación poco frecuente de la vasculitis asociada a anticuerpos anti-citoplasma de neutrófilo (ANCA). La literatura describe compromiso de sistema nervioso central (SNC) en 2-8% de los casos en pacientes con vasculitis pauciinmune. Se presenta el caso de un paciente con antecedente de vasculitis anti-mieloperoxidasa (MPO) con un mes de evolución de cefalea hemicraneana izquierda. La resonancia magnética cerebral contrastada evidencia marcado engrosamiento y realce meníngeo dural en el hemicráneo izquierdo, predominante en el tentorio y la fosa posterior. Se descartaron causas infecciosas por lo que se llegó a la conclusión de compromiso meníngeo asociado a vasculitis. Se inició manejo inmunosupresor con mejoría del cuadro clínico. La rápida identificación y manejo de esta entidad puede cambiar su pronóstico sombrío. Se realizó una revisión de la literatura para brindar una herramienta para la toma de decisiones para los médicos que se enfrentan a esta entidad.

Hypertrophic pachymeningitis (PH) is a rare manifestation of vasculitis associated with anti-neutrophil cytoplasm antibodies (ANCA). The literature describes central nervous system (CNS) involvement in 2-8% of cases in patients with pauciimmune vasculitis. We present the case of a patient with a history of anti-Myeloperoxidase (MPO) vasculitis with a 1-month history of left-sided headache. Contrast brain magnetic resonance was performed with evidence of marked thickening and dural meningeal enhancement in the left hemicranium, predominantly in the region of the tentorium and posterior fossa. Infectious causes were ruled out and the meningeal compromise associated with vasculitis was concluded. Immunosuppressive management was started with improvement of the clinical picture. Rapid identification and management of this entity can change its bleak outlook. A systematic review of the literature was carried out in order to provide a decision-making tool for physicians facing this entity.

Paquimeningitis asociada a enfermedad por IgG4 / Pachymeningitis associated with IgG4 disease

La paquimeningitis hipertrófica es una enfermedad infrecuente. Puede ser idiopática, secundaria a infección o enfermedad oncológica. Recientemente se la describió asociada a la enfermedad por IgG4, pudiendo ser esta la causa de muchas clasificadas como idiopáticas. Se presenta el caso de un hombre de 60 años de edad con historia de cefalea y epiescleritis, con respuesta parcial a corticoides. La resonancia magnética con contraste evidenciaba refuerzo meníngeo a nivel temporal y occipital izquierdo con extensión a la tienda del cerebelo. La biopsia meníngea demostró fibrosis e infiltrado linfoplasmocitario con más de 10 células plasmáticas IgG4 positivas por campo de gran aumento. El tratamiento con rituximab provocó mejoría clínica y radiológica. La paquimeningitis hipertrófica es una manifestación de la enfermedad por IgG4 y debe ser sospechada con la resonancia magnética y niveles plasmáticos altos de IgG4.

Hypertrophic pachymeningitis is an infrequent disorder. It can be idiopathic or secondary to infectious, autoimmune or neoplastic disease. The recently described ‹IgG4-related disease› could be the origin of many cases considered cryptogenic. We present the case of a 60-year-old man, with a history of headache and episcleritis in both eyes, with partial response to corticoid therapy. The brain MR study with gadolinium showed enhancement and thickening of the dura mater, extending from lateral wall of left temporal and occipital lobes to ipsilateral tentorium. Meningeal biopsy showed fibrosis and lymphoplasmacytic infiltrate, with more than 10 IgG4+ plasma cells per high power field. After treatment with rituximab there was clinical improvement accompanied by the virtual disappearance of the alterations detected in neuroimaging. Hypertrophic pachymeningitis as a manifestation of IgG4-related disease can be based on MRI findings if plasma IgG4 are elevated.

Diagnóstico etiológico en meningitis y encefalitis por técnicas de biología molecular / Etiologic diagnosis in meningitis and encephalitis molecular biology techniques

Introducción: El estudio etiológico de las infecciones del sistema nervioso central se ha realizado tradicionalmente con cultivos bacterianos y con reacción en cadena de la polimerasa (PCR) para virus herpes simple (VHS). Los cultivos bacterianos pueden disminuir su rendimiento en pacientes que hayan usado antibióticos previos a la toma de muestra, y el solicitar PCR solo para virus VHS reduce el diagnóstico etiológico a un solo agente. El objetivo de este trabajo fue determinar las causas infecciosas en meningitis y encefalitis en niños, utilizando conjuntamente la microbiología convencional y la biología molecular, con el fin de mejorar el diagnóstico etiológico de estas enfermedades. Pacientes y método: Se estudiaron 19 pacientes con sospecha de meningitis y encefalitis, de manera prospectiva, hospitalizados en el hospital Luis Calvo Mackenna en Santiago de Chile, entre el 1 de marzo de 2011 y el 30 de marzo de 2012. Luego de obtener el consentimiento informado, a las muestras de LCR se les realizó examen citoquímico, cultivo, PCR múltiple bacteriana (N. meningitidis, S. pneumoniae, H. influenzae) y PCR en tiempo real para HSV-1 y 2, VVZ, VEB, CMV, VHH-6 y enterovirus. Se recabaron datos clínicos y epidemiológicos desde la ficha clínica del paciente. Resultados: De los 19 pacientes analizados 2 (10%) fueron diagnosticados por métodos microbiológicos convencionales y 7 (37%) al adicionar biología molecular (p = 0,02). Tres pacientes presentaron meningitis por S. pneumoniae, uno por Enterobacter cloacae, 2 pacientes meningoencefalitis por VHS-1 y uno meningitis por VVZ. Conclusiones: La adición de la PCR a los métodos microbiológicos convencionales de diagnóstico en las infecciones del sistema nervioso central aumenta significativamente la probabilidad de detectar el agente causal. La incorporación rutinaria del diagnóstico molecular permitiría un manejo más oportuno y racional.

Introduction: The aetiological study of infections of the central nervous system has traditionally been performed using bacterial cultures and, more recently, using polymerase chain reaction (PCR) for herpes simplex virus (HSV). Bacterial cultures may not have good performance, especially in the context of patients who have received antibiotics prior to sampling, and a request for HSV only by PCR reduces the information to only one aetiological agent. The aim of this study is to determine the infectious causes of meningitis and encephalitis, using traditional microbiology and molecular biology to improve the aetiological diagnosis of these diseases. Patients and method: A prospective study was conducted on 19 patients with suspected meningitis, admitted to the Luis Calvo Mackenna Hospital in Santiago, Chile, from March 1, 2011 to March 30, 2012. After obtaining informed consent, the CSF samples underwent cytochemical study, conventional culture, multiplex PCR for the major producing bacterial meningitis (N. meningitidis, S. pneumoniae, H. influenzae), real-time single PCR for HSV-1 and 2, VZV, EBV, CMV, HHV-6 and enterovirus. Clinical and epidemiological data were also collected from the clinical records. Results: Of the 19 patients analysed, 2 were diagnosed by conventional methods and 7 by adding molecular biology (increase to 37%). Three patients had meningitis due to S. pneumoniae, one due to Enterobacter cloacae, 2 patients meningoencephalitis HSV-1, and one VZV meningitis. Conclusions: The addition of PCR to conventional diagnostic methods in CNS infections increases the probability of finding the causal agent. This allows a more adequate, timely and rational management of the disease.

Pneumorraquis, espondilitis y meningitis secundarios a cistitis enfisematosa / Pneumorrhachis, spondylitis and meningitis secondary to emphysematous cystitis. Report of one case

We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses.

Efecto de la temperatura de refrigeración y calentamiento de fórmulas lácteas Infantiles en el crecimiento de cronobacter sakazakii / Effect of temperature cooling and heating of powered infant formula on the growth of cronobacter sakazakii

Cronobacter sakazakii (C. sakazakii) es un microorganismo perteneciente a la familia Enterobacteriaceae asociado con patologías como meningitis y septicemia en recién nacidos. Las fórmulas lácteas infantiles (FLI) han sido reconocidas como el vehículo más importante de transmisión de C. sakazakii, por condiciones inadecuadas durante su producción o preparación. El objetivo de la presente investigación fue evaluar el efecto de la temperatura de refrigeración y el calentamiento de las FLI en el crecimiento de C. sakazakii. Las muestras de FLI reconstituidas se contaminaron con 102, 104 y 106 UFC/mL de C. sakazakii y se refrigeraron durante cuatro horas a 4°C, 6°C y 10°C, posterioriormente, se calentaron en baño hidrotérmico hasta 37°C. Las muestras fueron sembradas al tiempo “0” (postrefrigeración) y luego del calentamiento hasta 37°C en placas con agar cromogénico y se incubaron a 35°C por 24h. Para el análisis de los datos se utilizó la prueba de Wilcoxon. Según los datos obtenidos no hubo variación significativa en la población de C. sakazakii en las FLI luego de 4 horas en refrigeración a 4°C, 6°C y 10°C; sin embargo, al calentar las fórmulas hasta 37°C, hubo en todos los casos una reducción de un ciclo logarítmico en la población de C. sakazakii con un valor de p = 0.0056 y Z= 2.752. Se concluye que el calentamiento a 37°C post-refrigeracion de las muestras, disminuye la población de C. sakazakii en FLI (p<0,05)(AU)

Cronobacter sakazakii (C. sakazakii) is a microorganism belonging to the family Enterobacteriaceae associated with diseases such as meningitis and sepsis in newborns. The powdered infant formula (PIF) have been recognized as the most important vehicle of transmission of C. sakazakii, by inadequate conditions during production or during its preparation. The aim of this investigation was to assess the effect of the cooling temperature and the heating of PIF in the growth of C. sakazakii. For this, PIF reconstituted samples were contaminated with 102, 104 and 106 CFU / mL of C. sakazakii and refrigerated for four hours at 4 ° C, 6 ° C or 10 ° C after this hydrothermal bath heated to 37 ° C. Samples were cultured at time “0” (after- cooling) and then heating to 37 ° C in chromogenic agar plates and incubated at 35 ° C for 24h . For data analysis we used the Wilcoxon test. According to the data there was no significant variation in the population of C. sakazakii in PIF after 4 hours in the refrigerator at 4 ° C, 6°C and 10 ° C , however , by heating the formulas to 37 ° C , in all cases there was a reduction of one log cycle in population C. sakazakii with a value of p = 0.0056 and Z = 2.752 . We conclude that heating at 37°C post- cooling of the samples, decreases the population of C. sakazakii in FLI ( p < 0,05 )(AU)

Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance

Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.

Neurosífilis meningovascular con trombosis de la arteria basilar / Meningovascular neurosyphilis with basilar artery thrombosis, a case report and literature review

Se presenta el caso clínico de un paciente de 54 años, negativo para VIH, con enfermedad cerebrovascular por trombosis de la arteria basilar, secundaria a neurosífilis meningovascular. La neurosífilis es el compromiso del sistema nervioso central por Treponema pallidum subespecie pallidum en cualquier estadio de la entidad e incluye las formas asintomáticas y sintomáticas de la infección; sus formas de presentación son diversas y dependen de la localización y la extensión de las lesiones. La recomendación actual es el tratamiento con 4 millones de unidades de penicilina cristalina cada 4 horas por 14 días.

Herein a case is described of a 54-years old patient, HIV negative, with cerebro-vascular disease by basilar artery thrombosis secondary to meningovascular neurosyphilis. Neurosyphilis is the impairment at any stage of the central nervous system by Treponema pallidum subspecies pallidum and includes asymptomatic and symptomatic forms of infection. The presentation can take many forms, depending on the location and extent of tissue damage. The currently recommended treatment is crystalline penicillin, 4 million units every 4 hours for 14 days.

Meningitis granulomatosa, glomerulonefritis rápidamente progresiva y vasculitis / Granulomatous meningitis, crescentic glomerulonephritis and vasculitis

El compromiso meníngeo es una manifestación infrecuente de la granulomatosis de Wegener. Puede manifestarse como cefalea con hiperproteinorraquia y engrosamiento de la duramadre con aspecto granulomatoso, que se observa en la resonancia magnética. Presentamos un varón de 57 años con granulomatosis de Wegener que debutó con compromiso de vías aéreas superiores, oídos, órbitas y meningitis granulomatosa asintomática y que posteriormente evolucionó con mononeuritis múltiple y glomerulonefritis crescéntica ANCA positiva. La presencia de ANCA y el compromiso sistémico (vías aéreas superiores, oído, órbitas, nervios periféricos, duramadre y glomerulonefritis rápidamente progresiva) permitieron en este caso llegar a un diagnóstico de certeza e iniciar el tratamiento inmunosupresor combinado (corticoides y ciclofosfamida). Evolucionó con remisión clínica y serológica (negativización de ANCA), pero persistiendo leve deterioro secuelar auditivo y de la función renal, sin recidiva de la enfermedad de base.

Meningeal involvement is an infrequent manifestation of Wegener's granulomatosis. Clinical manifestations can be headache with high protein level in the cerebrospinal fluid and an enhanced MRI signal of granulomatous thickening of the duramater in the brain. We report a 57 year-old male with Wegener granulomatosis with onset manifestations of asymptomatic granulomatous meningitis, upper respiratory tract, ears and orbits involvement. He progressively developed ANCA positive multiple mononeuritis and crescentic glomerulonephritis. The diagnostic confirmation of Wegener's granulomatosis based on a positive ANCA test and on the evidence of systemic disease (crescentic glomerulonephritis and involvement of the upper respiratory tract, ears, orbits, peripheral nerves and duramater) allowed a prompt initiation of aggressive immunosuppressive treatment with systemic cyclophosphamide and high - dosis corticosteroids. The patient entered into a sustained clinical remission with mild residual neurosensorial hearing loss and renal failure.

Imaging in adult patients with acute febrile encephalopathy: What is better computerized tomography or magnetic resonance imaging.

Context: Imaging techniques are commonly used by emergency physicians in a febrile comatose patient. Their utility requires judicious use of the available resources. In this study, we have compared the efficacy of cranial imaging techniques in adult patients with acute febrile encephalopathy. Materials and Methods: This prospective observational study enrolled 101 patients presenting to the emergency with fever of less than 15 days duration and altered sensorium. All the patients were subjected to routine investigations, detailed cerebrospinal fluid analysis, computerized tomograms (noncontrast followed by contrast enhanced), and magnetic resonance imaging of the brain. Final diagnosis was reached after considering the clinical, biochemical findings, imaging results, and response to therapy. The positive yield of radiological investigations was compared against the final diagnosis. Results: The patients were divided into three groups. Forty-eight had evidence of meningoencephalitis, 22 patients had pyogenic meningitis, and 20 were combined together in other group. In 12 patients, a definitive diagnosis could not be made. Only 37% patients were detected to have abnormal computerized tomograms and the most common abnormality was diffuse edema, which failed to point to an etiological diagnosis. Magnetic resonance imaging was abnormal in 62.75% cases and was able to suggest an etiological diagnosis in 100% cases of cerebral venous thrombosis, tubercular meningitis, 95% cases of meningoencephalitis, and 45% patients with meningitis. Conclusions: We can conclude that magnetic resonance imaging provides better information than computerized tomography in adult patients with acute febrile encephalopathy.

Incidência das meningites no Estado do Rio de Janeiro no período de 2000 a 2006 / Incidence of meningitis in the state of Rio de Janeiro, in the period of 2000 to 2006

As meningites são um importante problema de saúde pública, em particular as de origem bacteriana, devido à maior chance de evolução com sequelas neurológicas ou óbito. No Estado do Rio de Janeiro, no entanto, existem poucos estudos sobre o tema. O objetivo deste trabalho foi realizar um estudo descritivo sobre a incidência das meningites ocorridas no Estado do Rio de Janeiro, no período de 2000 a 2006. Os dados foram extraídos do banco de dado do Sistema de Informações de Agravos de Notificação (SINAN). Foram calculadas as taxas de incidência padronizada de meningite e a variação percentual relativa no período. A taxa de incidência padronizada de meningite para o Estado do Rio de Janeiro variou de 14,5 em 2000 a 11,1 por 100 mil em 2006, com uma variação percentual relativa de 23,3%. A maior taxa média de incidência ocorreu no município de Carapebus (25,3 por 100 mil). Observou-se uma queda na taxa de incidência por meningite no Estado do Rio de Janeiro, no último ano do período estudado.

Meningitis is an important public health problem, particularly those of bacterial origin, due to higher chance of evolve with neurological sequelae or death. In the State of Rio de Janeiro, however, there are few studies about the issue. The objective of this work was to perform a descriptive study of the incidence of meningitis that occurred in State of Rio de Janeiro, Brazil, in the period of 2000 to 2006. Data were obtained from the Information System Notification Diseases (SINAN) Database.The meningitis incidence rates were calculated, in standard way, and the percentage change in the period. The standardized incidence rate of meningitis in the State of Rio de Janeiro ranged from 14.5 in 2000 to 11.1 per 100 000 in 2006, with a relative percentage change of 23,3%. The highest average incidence rate occurred in the municipality of Carapebus (25.3 per 100,000). There was a decrease in the incidence rate of meningitis in the State of Rio de Janeiro, in the last year of the studied period.

CNS diseases and uveitis

A number of inflammatory, infectious, neoplastic and idiopathic disorders affect the eye and the central nervous system [CNS] concurrently or at different time frames. These conditions pose a diagnostic challenge to the clinician since they may present with similar ocular and neurological manifestations. The purpose of this review is to describe major neurological syndromes including multiple sclerosis, Vogt-Koyanagi-Harada disease, other autoimmune syndromes, and several infectious diseases which may affect the eye. This article may serve as a guide for the diagnosis and treatment of such disorders. It should be noted that these conditions have been viewed from a neurologist's perspective thereby neurologic involvement is stressed

Valor pronóstico y discriminatorio de la interleucina-6 y la proteína C-reactiva en la meningitis / Interleukin-6 and C-reactive protein and its prognosis and differentiation value in meningitis

La meningitis se caracteriza por una marcada respuesta inflamatoria en el espacio subaracnoideo, que se acompaña de la producción intratecal de múltiples mediadores entre los que se hallan citocinas como el factor de necrosis tumoral alfa, la interleucina-1-beta y la interleucina-6. El objetivo del presente estudio fue estimar la concentración de interleucina-6 (IL-6) y proteína C-reactiva en el líquido cefalorraquídeo y el suero de pacientes con meningitis; determinar la posible relación entre estas concentraciones y la etiología de la meningitis; y precisar si existe asociación entre estas variables y la estadía hospitalaria. Se seleccionó una muestra de 18 pacientes con meningitis: 6 pacientes con diagnóstico de meningitis de etiología bacteriana y 12 pacientes con diagnóstico de meningitis aséptica. A ambos grupos se les realizó cuantificación de IL-6 y proteína C-reactiva en el líquido cefalorraquídeo (LCR) y el suero, además, citología y proteínas en LCR. Las concentraciones de IL-6 en el líquido cefalorraquídeo en la meningitis bacteriana resultaron superiores a las del suero de estos pacientes y a las del LCR y suero de pacientes con meningitis aséptica. La proteína C-reactiva alcanzó cifras superiores en el suero de la meningitis bacteriana. La concentración de IL-6 en líquido se correlacionó directamente con la estadía hospitalaria. La concentración de IL-6 en el líquido cefalorraquídeo y de la proteína C-reactiva en el suero puede contribuir a la precisión del diagnóstico diferencial entre meningitis aséptica y bacteriana. La concentración de IL-6 en el LCR permite valorar la envergadura del proceso inflamatorio que tiene lugar en el sistema nervioso central en la meningitis. La concentración de IL-6 selectivamente elevada en el LCR es un marcador de la compartimentalización de la respuesta inflamatoria y un potencial indicador del daño en el sistema nervioso central en la meningitis bacteriana.

Meningitis is characterized by a marked inflammatory response in subarachnoid space, accompanied by the intrathecal production of many mediators including cytokines as ß-tumor necrosis factor, â-interleukin-1 and interleukin-6. The aim of present paper was to estimate the concentration of interleukin-6 and C-reactive protein in the cerebrospinal fluid (CSF), and in serum from meningitis patients; to determine the possible relation among these concentrations, and meningitis etiology, and to set if there is an association among these variables and hospital stay. A sample of 18 patients presenting with meningitis was selected: 6 patients diagnosed with meningitis of bacterial origin and 12 patients diagnosed with aseptic meningitis. In both groups we quantified interleukin-6 and C-reactive protein in CSF and in serum, as well as cytology and proteins in CSF. Concentrations of interleukin-6 in CSF in bacterial meningitis were higher than those of serum from these patients, and than those of CSF and serum from aseptic meningitis patients. C-reactive protein reached figures higher in bacterial meningitis serum. Interleukin-6 concentration in CSF was directly correlated with hospital stay. Interleukin-6 in CSF and of C-reactive protein in serum may to contribute to the accuracy in differential diagnosis between aseptic meningitis and the bacterial one. Interleukin-6 concentration in CSF allows us to assess the significance of inflammatory process in the CNS in meningitis. The selectively high interleukin-6 concentration in CSF is a marker to compartmentalize the inflammatory response, and a potential damage indicator in CNS in bacterial meningitis.

Recurrent meningitis secondary to isolated C3 deficiency.

A 5-year-old child presented with the second episode of meningitis when we started investigating her to find a cause for recurrent episode of meningitis. During this she suffered from a third attack after which she was diagnosed as having isolated C(3) deficiency. She was put on penicillin prophylaxis and vaccinated against encapsulated bacteria, after which she is now doing well.

Current Concept in the Management of Acute Bacterial Meningitis

"Though largely considered a disease of the so called dry and hot ""African meningitis belt;"" meningitis is assuming a global public health problem. Recent emergence of resistant strains of bacteria has resulted in increased morbidity of and mortality attributable to meningitis. This review addresses recent developments in the pathogenesis and diagnosis of this largely neglected disease as well as their implications for its management. A preventive strategy; particularly mass vaccination is advocated. The possible impact of climate change in the epidemiology of meningitis is highlighted."

Estudio de 312 niños con meningitis atendidos en un Hospital Universitario en el Sur de Brasil / Study of 312 children with meningitis treated at a University Hospital in the South of Brazil

El objetivo de este trabajo fue evaluar los aspectos clínicos, análisis de laboratorio, el perfil etiológico y las características evolutivas de los distintos tipos de meningitis aguda atendidos en un Servicio de Pediatría de un Hospital Público Universitario. Fueron evaluados a partir de un estudio descriptivo y retrospectivo de niños atendidos en el Servicio de Pediatría del Hospital de Clínicas de la Universidad Federal del Paraná, durante el periodo entre enero 2003 a enero 2007, con el diagnóstico probable de meningitis basado en manifestaciones clínicas y en alteraciones citológicas y bioquímicas del LCR. Se diagnosticó meningitis viral (MV) en 140 niños (45%), meningitis bacteriana (MB) en 58 (19%) y en 114 la etiología fue indeterminada (36%). Entre las MB el agente etiológico más frecuente fue Neisseria meningitidis (25 casos). Lo datos clínicos predominantes fueron fiebre, vómitos y cefalea. En el LCR de la MB hubo predominio de polimorfonucleares, proteína elevada y glucosa baja. En la MV predominaron los mononucleares. Las complicaciones neurológicas fueron más frecuentes en la MB, siendo la convulsión el hallazgo más común (6/58 pacientes). El óbito ocurrió en un caso en la MV y tres en la MB. Se llegó a la conclusión de que la clásica tríada fue la manifestación clínica más común, las anormalidades citológicas y bioquímicas fueron típicas auxiliando en la diferenciación entre las MB y MV, aunque un gran número de casos haya quedado sin definición etiológica; las complicaciones neurológicas inmediatas y los óbitos han sido pocos frecuentes en esta muestra.

The aim of this study is to evaluate the clinical and laboratorial aspects, as well as the etiological profile and the evolution characteristics, of the diverse types of severe meningitis treated at a Pediatric Clinic of a public university hospital. From a descriptive and retrospective study, 312 children at the Pediatric Clinic of the Hospital de Clínicas of the Federal University of Paraná were evaluated between January 2003 and January 2007. All of them had a probable diagnosis of meningitis based on clinical signs, and on the cytological and biochemical alterations in the cerebrospinal fluid routine examination. Viral meningitis (VM) was present in 140 children (45%), 58 had bacterial meningitis (BM - 19%) and etiology was undetermined in 114 (36%). In MB, Neisseria meningitidis was the most frequent etiological agent (25 cases). Predominant clinical symptoms were fever, sickness and headache. The cerebrospinal fluid test showed a high number of polymorphonuclear leukocytes, high protein and low glucose level in MB; mononuclear cells were predominant in VM. Neurological complications were more frequent in BM, and convulsion the most common symptom (6/58 patients). Death happened to one case in VM and 3 in BM. Our conclusions were that the classical triad (headache, vomiting and fever) was the most common clinical manifestation, the cytological and biochemical abnormalities were typical, helping in the differentiation of MB from VM, although a good number of cases ended up with no etiological definition and, finally, immediate neurological complications and death were rare.