Initial treatment with amphotericin B plus rifampin in the acute treatment of cryptococcal meningitis in aids.

The result of initial treatment with amphotericin B (0.7 mg/kg/day) plus rifampin (600 mg/day) for 2 weeks, followed by fluconazole (400 mg/day) for 8 weeks in the acute treatment of cryptococcal meningitis in AIDS is reported. There were 10 patients in the study: at 2 weeks, all had made a clinical response and cerebrospinal fluid was sterile in 4 patients; at 10 weeks, all had negative cerebrospinal fluid cultures. Serious side effects were not detected.

Immunoblot evaluation of the specificity of the 29-kDa antigen from young adult female worms Angiostrongylus cantonensis for immunodiagnosis of human angiostrongyliasis.

The antigenic components of Angiostrongylus cantonensis young adult female worm somatic extract (FSE) were revealed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. The sera tested were from patients with proven angiostrongyliasis, other parasitic diseases, and healthy adults. Both the sera and cerebrospinal fluid (CSF) were tested from patients with clinical angiostrongyliasis. The CSF from patients with other neurological diseases were also included. Using SDS-PAGE, we found that the FSE comprised more than 30 polypeptides. Immunoblot analysis revealed at least 12 or 13 antigenic bands in patients with proven or clinical angiostrongyliasis, respectively. The patterns of reactivity recognized by the serum and CSF antibodies against FSE were similar. These antigenic components had molecular masses ranging from less than 14.4 to more than 94 kDa. The prominent antigenic band of 29-kDa might serve as a reliable marker for the diagnosis of angiostrongyliasis. The sensitivity, specificity, positive and negative predictive values of immunoblot analysis in this antigenic band were 55.6%, 99.4%, 83.3% and 97.4%, respectively.

Microaerophilic streptococcus meningoencephalitis: report of a case.

A 64-year-old woman who presented with acute meningoencephalitis was reported. Cerebrospinal fluid (CSF) revealed polymorphonuclear pleocytosis with gram-positive cocci. Blood and CSF grew microaerophilic streptococcus. The patient was treated with intravenous penicillin G and chloramphenicol for 2 weeks and recovered without sequela. There was no evidence of any focus of infection prone to the development of this infection.

Asymmetrical polyneuropathy associated with Churg-Strauss syndrome.

A 26-year-old man who presented with fever, leg edema, weakness and numbness of both hands and feet and painless palpable purpura was reported. He had had a history of asthma and arthalgia before this admission. Physical examination revealed distal asymmetrical polyneuropathy. Electrodiagnostic study was consistent with polyneuropathy. Skin biopsy revealed vasculitis with prominent eosinophilic infiltration. His motor power was markedly improved by prednisolone treatment.

Tuberculous meningitis associated with urinary tract tuberculosis.

The association of tuberculous meningitis (TBM) and urinary tract tuberculosis is very rare. Two cases of this condition are reported. Both presented with subacute to chronic meningitis with lymphocytic pleocytosis, elevation of protein content and depression of glucose level of cerebrospinal fluid. Pyuria and hematuria were detected and Ziehl-Neelsen's stain was positive for acid fast bacilli (AFB). Urographic abnormalities were compatible with urinary tract tuberculosis. AFB smear of urine is the simplest method to detect urinary tract tuberculosis.

Superior branch palsy of the oculomotor nerve caused by rhinocerebral mucormycosis.

A 75-year-old woman presented with fever and right temporal, periorbital and facial pain for 7 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with mild exophthalmos. She also had hyperglycemia. CT scan of the paranasal sinuses showed acute sinusitis. Rhinoscopy demonstrated black necrotic tissue in the nasal septum. KOH preparation of tissue biopsy specimen revealed large, non septate hyphae with right angle branching, diagnostic of rhinocerebral mucormycosis. She was treated with amphotericin B, surgical debridement and insulin therapy. Surgical tissue specimen also confirmed mucormycosis. She improved after treatment, but 4 months later, ptosis and upward palsy still persisted.

Acute polyradiculoneuropathy with cerebrospinal fluid eosinophilia.

A 60-year-old woman who presented with quadriparesis, dysarthria and dysphagia after acute febrile illness was reported. Neurological examination and electrodiagnostic study were compatible with acute polyradiculoneuropathy. Lumbar puncture revealed cerebrospinal fluid eosinophilia. Her muscle power improved after supportive treatment.

Mitochondrial myopathy with respiratory dysfunction: a case report.

A 50-year-old woman who presented with infective bronchiectasis and respiratory insufficiency was reported. Mitochondrial myopathy was diagnosed from a long history of chronic bilateral ptosis and external ophthalmoplegia with muscle wasting. Muscle biopsy revealed ragged-red fibers. After treatment with appropriate antibiotic and respiratory assistance, the patient improved and returned to her usual state of health.

Community acquired-bacterial meningitis in adults.

We reviewed the charts of all patients > or = 15 years of age or older in whom community acquired-bacterial meningitis was diagnosed at Srinagarind Hospital, Khon Kaen, Thailand from 1984 through 1998. Eighty-five patients were included in this study. The clinical manifestation was acute meningitis with CSF neutrophilic pleocytosis and low glucose content. Gram's staining of CSF was positive in 79%. The most common pathogens were Streptococcus pneumoniae (28%) and Escherichia coli (14%) respectively. The overall mortality was 34%.

Brain abscess in a patient with atrial septal defect.

Brain abscess rarely occurs in adults with congenital heart disease. A 59-year-old man who presented with headache, fever and stiffness of the neck was reported. The patient had a atrial septal defect with pulmonary hypertension and atrial fibrillation. CT scan of the brain demonstrated an abscess at the right parieto-occipital lobe. The patient was successfully treated with appropriate antibiotics.

Streptococcus suis meningitis: report of a case.

A 50-year-old policeman who presented with subacute meningitis, bilateral rectus muscle palsies, dizziness and early bilateral deafness was reported. Cerebrospinal fluid (CSF) revealed polymorphonuclear pleocytosis with Gram-positive cocci. Blood and CSF cultures grew Streptococcus viridans which subsequently identified to be Streptococcus suis. The patient improved after treatment but deafness persisted.

Horizontal conjugate gaze palsy in eosinophilic meningitis.

Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be Angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.

Amyotrophic lateral sclerosis syndrome and hyperthyroidism: report of 4 patients.

Four patients with clinical diagnosis of amyotrophic lateral sclerosis syndrome and laboratory results of hyperthyroidism were reported. There were 3 women aged 27, 59, 59 years and 1 man aged 50 years. All of them had symptoms and signs of dysarthria and dysphagia, fasciculations of the tongue, muscle weakness with generalized hyperreflexia. After treatment with antithyroid drugs, motor weakness and dysphagia improved.

Superior branch palsy of the oculomotor nerve caused by acute sphenoid sinusitis.

A 52-year-old man presented with unilateral headache for 6 days. Physical examination revealed an ipsilateral paresis of the superior division of the oculomotor nerve with chemosis. CT scan of the paranasal sinuses showed ipsilateral sphenoid sinusitis with cavernous sinus involvement. The symptoms were completely improved by medical treatment only.

Maintenance therapy with itraconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome.

We conducted a prospective, open trial to establish the efficacy of itraconazole 400 mg/d as maintenance treatment for cryptococcal meningitis in AIDS patients. Between February 1996 and May 1997, 50 patients were included for analysis. After a mean follow-up of 326 days, 2 of 38 patients (5.3 per cent) had relapses of symptomatic cryptococcal meningitis. Hepatotoxicity occurred in 2 cases. In conclusion, maintenance therapy with itraconazole 400 mg/d is effective in preventing recurrent cryptococcal meningitis.

Comparison of amphotericin B, flucytosine and itraconazole with amphotericin B and flucytosine in the treatment of cryptococcal meningitis in AIDS.

We compared amphotericin B (0.3 mg/kg/d) plus flucytosine (150 mg/kg/d) plus itraconazole (400 mg/d) (study group) with amphotericin B plus flucytosine (control group) by an open-randomized trial. In the study group, after CSF mycological cultures disclosed nothing, itraconazole was administrated alone through six weeks of treatment. Treatment was considered successful if the patient had two consecutive negative CSF cultures by the end of the 6-week treatment period. Fifty patients were enrolled in each group. There were significant differences between the study group and the control group in the successful treatment (100% vs 90%; P = 0.03), the mean length of time until normal body temperature after treatment (5.9 +/- 3.7 days vs 8.8 +/- 5.1 days; P = 0.02) and the adverse effects. The mean length of time to the first negative CSF culture was 13.9 +/- 6.1 days in the study group and 13.3 +/- 6.5 days in the control group (P = 0.66). Relapse rate with itraconazole 200 mg/day was higher in the study group.

Burkholder meningitis.

We report two cases of Burkholder meningitis. Case 1 presented with subacute lymphocytic meningitis, low sugar profile in CSF and positive culture for Burkholder. Case 2 presented with purulent meningitis that emerged during treatment of cryptococcal meningitis which, to our knowledge, has not been reported. Thus, Burkholder should be considered as one of the etiologic agents in this clinical setting.

Corticosteroid in tuberculous meningitis.

We assessed the benefit of prednisolone regimen in adult-patients with tuberculous meningitis by a randomised, double-blind trial. 59 patients were treated with combined antituberculous drugs and randomised to receive oral prednisolone regimen or a placebo. There were 29 and 30 patients in the treatment and placebo groups respectively. The results revealed that prednisolone was not beneficial in patients with severe brain lesions, increased intracranial pressure and cranial nerve palsies. The role of prednisolone in patients with paraparesis, visual impairment and newly developed neurological complications during treatment needs further study.

Treatment of cryptococcal meningitis with combination itraconazole and flucytosine.

The results of an open study of the efficacy of itraconazole and flucytosine in 10 patients with cryptococcal meningitis are reported. The outcome revealed eight responding cases (cure in 4 cases and improvement in 4 cases), and two failure cases. One patient had a relapse which responded to amphotericin B and flucytosine. No toxicity was observed.