Coinfección por astrovirus y Neisseria meningitidis serogrupo B en una niña / Coinfection by astrovirus and Neisseria B meningitidis in a girl

La infección meningocócica tiene una elevada morbimortalidad. Las coinfecciones virales han sido descritas, fundamentalmente, por virus herpes y respiratorios. Se presenta una paciente que ingresó al Servicio de Emergencia con convulsión tónico-clónica, hipotensión, taquicardia y escala de Glasgow posterior baja. En la Unidad de Cuidados Intensivos mantuvo alteración del nivel de conciencia y requirió estabilización hemodinámica. Se inició antibioterapia de amplio espectro. La paciente mostró deposiciones líquidas malolientes, sin sangre, que fueron cultivadas y estudiadas mediante reacción en cadena de la polimerasa. El líquido cefalorraquídeo fue normal. Las deposiciones resultaron positivas para astrovirus. Se confirmó, mediante reacción en cadena de la polimerasa en sangre, la presencia de Neisseria meningitidis serogrupo B. Se presenta el primer caso pediátrico de coinfección por astrovirus y Neisseria meningitidis. Este virus debería incluirse entre las causas de coinfección para descartar en caso de clínica abdominal predominante, vómitos o deposiciones líquidas.

Meningococcal infection associates high morbidity and mortality. Viral coinfection has been described mainly with herpes and respiratory virus. We describe a child who suffered a tonic-clonic seizure with hypotension, tachycardia and low Glasgow Coma Scale. She maintained an altered mental status and required hemodynamic stabilization in the Pediatric Intensive Care Unit. Wide spectrum antibiotherapy was initiated. She suffered large and foul-smelling liquid not bloody stools which were cultured and studied by polymerase chain reaction. The cerebrospinal fluid was normal. Later the polymerase chain reaction stools were positive to astrovirus, and the blood polymerase chain reaction was positive to Neisseria meningitidis group B. As far as we know, this is the first case of astrovirus and Neisseria meningitidis coinfection described in children. This virus should be considered as new cause of viral coinfection to discard if unexplained abdominal pain or vomits and liquid stools are observed.

Profile of tuberculous meningitis with or without HIV infection and the predicators of adverse outcome / Perfil de la meningitis tuberculosa con o sin infección por VIH y predictores de la evolución clínica adversa

OBJECTIVES: To compare the clinical, radiological and cerebrospinal fluid (CSF) findings, at hospital admission, among adult patients with tuberculous meningitis (TBM) with or without HIV infection and to identify the factors that predict adverse outcome at six months. METHODS: A total of 82 adult patients with TBM were included (40 HIV-positive and 42 HIV-negative). Several clinical (duration of illness, Glasgow Coma Scale score, presence of high temperature, headache, cranial nerve or sphincter abnormality, seizures and endocrine dysfunction), radiological (presence of hydrocephalus, cerebral infarction and oedema, meningeal enhancement, granuloma) and cerebrospinal fluid parameters (glucose, protein, lactate, lymphocytes, neutrophils and adenosine deaminase values) were recorded along with CD4 count in the peripheral blood. Statistical analysis was performed using the chi-square test. Individual variables were evaluated as prognostic factors for adverse outcome in both groups by calculating the relative risk of association for each. RESULTS: Temperature more than 38.33ºC was more common in the HIV-negative group while seizures, hydrocephalus, cerebral infarction and low CD4 count occurred significantly more commonly in the HIV-positive group. Hydrocephalus had strong association with severe neurological deficit and seizure with death in both the groups. CONCLUSION: Several clinical and laboratory features of TBM in patients who are HIV-positive are distinctly different from those without HIV infection; some of these have an association with the probability of adverse outcome.

OBJETIVOS: Comparar los hallazgos clínicos, radiológicos y del líquido cefalorraquídeo (LCR) entre pacientes adultos con meningitis tuberculosa (MTB) con o sin infección de VIH en su ingreso al hospital, e identificar los factores que predicen la evolución clínica adversa en seis meses. MÉTODOS: Un total de 82 pacientes adultos con MTB fueron incluidos (40 VIH positivos y 42 VIH negativos). Se registraron varios parámetros: clínicos (duración de la enfermedad, puntuación de la Escala de Coma de Glasgow, presencia de alta temperatura, dolor de cabeza, anormalidad del esfínter o nervio craneal, o anormalidad del esfínter, convulsiones y disfunción endocrina); radiológicos (la presencia de hidrocefalia, infarto cerebral, edema, realce meníngeo, granuloma); y del líquido (glucosa, proteína, lactato, linfocitos, neutrófilos, y valores de adenosina deaminasa), junto con un conteo de CD4 en la sangre periférica. Se realizó un análisis estadístico usando la prueba de chi-cuadrado. La variable individual se evaluó como factor pronóstico de la evolución clínica en ambos, calculando el riesgo relativo de asociación para cada uno. RESULTADOS: Una temperatura de más de 38.33ºC fue más común en el grupo VIH negativo, mientras que convulsiones, hidrocefalia, infarto cerebral, y bajo conteo de CD4 ocurrieron significativamente más normalmente en el grupo VIH positivo. La hidrocefalia estuvo fuertemente asociada con un déficit neurológico severo y la convulsión con la muerte en ambos grupos. CONCLUSIÓN: Varias características clínicas y de laboratorio del MTB en pacientes que son VIH positivos, difieren claramente de aquellos con infección por VIH. Algunas de estas características se hallan asociadas con la probabilidad de una evolución clínica adversa.

Neurocysticercosis like presentation in a case of CNS tuberculosis.

A clinical picture consisting of seizures, multiple non-tender subcutaneous nodules, and multiple 'nodular or ring' enhancing lesions in computed tomography of the brain is considered characteristic of neurocysticercosis in an endemic area. 1,2 A case with a similar clinical picture, in whom serological tests and histopathological examination of subcutaneous nodule established tuberculosis as a cause, is presented.

Retrospective review of clinical and neuroimaging observations in pyomeningitis.

The present study is a review of patients with pyogenic meningitis diagnosed by clinical and laboratory criteria in which CT scan was done to detect acute phase CT abnormalities with respect to post inflammatory hydrocephalus and ventriculomegaly. Fifty-six patients were identified between 1993 and 1996 in the Department of Pediatrics at the All India Institute of Medical Sciences, New Delhi. A CT scan was available in 30. The diagnosis was compatible with a definitive pyogenic meningitis in 17 and probable pyogenic meningitis in 13. The acute stage CT scans performed within the first four weeks of illness revealed ventriculomegaly in 10 out of 30 bacterial meningitis (33%), (41.1% of definitive meningitis compared to only 23% of the probable meningitis group). Follow-up CT scans revealed persistent ventriculomegaly in 2. Both patients with persistent ventriculomegaly had frontal atrophy. None of the patients merited a shunt or any medical measures. Cortical atrophy as an aftermath of acute bacterial meningitis may cause persistent ventriculomegaly. The frontal cortex localization may explain the frequency of seizures and other sequelae observed in pyogenic meningitis. An early recognition may help to prognosticate patient outcome.