Preformulation screening of lipids using solubility parameter concept in conjunction with experimental research to develop ceftriaxone loaded nanostructured lipid carriers

Abstract Development of ceftriaxone loaded nanostructured lipid carriers to increase permeability of ceftriaxone across uninflamed meninges after parenteral administration. Lipids were selected by theoretical and experimental techniques and optimization of NLCs done by response surface methodology using Box-Behnken design. The Δδt for glyceryl monostearate and Capryol90 were 4.39 and 2.92 respectively. The drug had maximum solubility of 0.175% (w/w) in glycerol monostearate and 2.56g of Capryol90 dissolved 10mg of drug. The binary mixture consisted of glyceryl monostearate and Capryol90 in a ratio of 70:30. The optimized NLCs particle size was 130.54nm, polydispersity index 0.28, % entrapment efficiency 44.32%, zeta potential -29.05mV, and % drug loading 8.10%. In vitro permeability of ceftriaxone loaded NLCs was 5.06x10-6 cm/s; evidently, the NLCs pervaded through uninflamed meninges, which, was further confirmed from in vivo biodistribution studies. The ratio of drug concentration between brain and plasma for ceftriaxone loaded NLCs was 0.29 and that for ceftriaxone solution was 0.02. With 44.32% entrapment of the drug in NLCs the biodistribution of ceftriaxone was enhanced 7.9 times compared with that of ceftriaxone solution. DSC and XRD studies revealed formation of imperfect crystalline NLCs. NLCs improved permeability of ceftriaxone through uninflamed meninges resulting in better management of CNS infections.

Clinical analysis of 11 cases of otogenic intracranial complications treated by multidisciplinary collaboration / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical diagnosis, treatment ，and surgical timing of otogenic intracranial complications. Methods:The clinical data of 11 patients with intracranial complications with ear symptoms as the first manifestation in Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University（Qingdao） from December 2014 to June 2022 were collected, including 8 males and 3 females, aged from 4 to 69 years. All patients had complete otoendoscopy, audiology, imaging and etiology examination, and the diagnosis and treatment plan was jointly developed through multidisciplinary consultation according to the critical degree of clinical symptoms and imaging changes. Among the 11 patients, 5 cases were treated with intracranial lesions first in neurosurgery department and middle ear lesions later in otolaryngology, 3 cases of meningitis, were treated with middle ear surgery after intracranial infection control, 1 case was treated with middle ear lesions and intracranial infection simultaneously, and 2 cases were treated with sigmoid sinus and transverse sinus thrombosis conservatively. They were followed up for 1-6 years. Descriptive statistical methods were used for analysis. Results:All the 11 patients had ear varying symptoms, including ear pain, pus discharge and hearing loss, etc, and then fever appeared, headache, disturbance of consciousness, facial paralysis and other intracranial complication. Otoendoscopy showed perforation of the relaxation of the tympanic membrane in 5 cases, major perforation of the tension in 3 cases, neoplasia in the ear canal in 1 case, bulging of the tympanic membrane in 1 case, and turbidity of the tympanic membrane in 1 case. There were 4 cases of conductive hearing loss, 4 cases of mixed hearing loss and 3 cases of total deafness. Imaging examination showed cholesteatoma of the middle ear complicated with temporal lobe brain abscess in 4 cases, cerebellar abscess in 2 cases, cholesteatoma of the middle ear complicated with intracranial infection in 3 cases, and sigmoid sinus thrombophlebitis in 2 cases. In the etiological examination, 2 cases of Streptococcus pneumoniae were cultured in the pus of brain abscess and cerebrospinal fluid, and 1 case was cultured in streptococcus vestibularis, Bacteroides uniformis and Proteus mirabilis respectively. During the follow-up, 1 patient died of cardiovascular disease 3 years after discharge, and the remaining 10 patients survived. There was no recurrence of intracranial and middle ear lesions. Sigmoid sinus and transverse sinus thrombosis were significantly improved. Conclusion:Brain abscess, intracranial infection and thrombophlebitis are the most common otogenic intracranial complications, and cholesteatoma of middle ear is the most common primary disease. Timely diagnosis, multidisciplinary collaboration, accurate grasp of the timing in the treatment of primary focal and complications have improved the cure rate of the disease.

Cerebrovascular changes in neuro-Behcet's disease and neuropsychiatric lupus by transcranial Doppler ultrasonography and magnetic resonance imaging

ABSTRACT Introduction: Transcranial Doppler ultrasonography (TCD) is a technique that allows measurement of blood flow from the basal intracerebral vessels. It is relatively inexpensive, non-invasive, can be performed at the bedside, and allows monitoring in acute emergency settings and for prolonged periods with a high temporal resolution, making it ideal for studying the haemodynamics within the intracranial arteries in neuro-Behcet's disease (NBD) and neuro-psychiatric lupus (NPSLE). Our aim was to assess the cerebral haemodynamic patterns in patients with NBD and NPSLE using TCD, while brain lesions were examined using magnetic resonance imaging (MRI). Material and methods: Case-control prospective study of 30 neuro-Behcet's disease patients, 25 neuro-psychiatric lupus patients and 26 healthy age-matched volunteers. All patients and healthy controls were examined by TCD. Only the groups of patients underwent cranial magnetic resonance imaging (MRI). Results: Transcranial Doppler (TCD) values for middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA) in NBD, NPSLE and control groups were measured. The results showed that there was a significant decrease in mean blood flow velocities in all the arteries examined in NBD and NPSLE patients. There was also a significant increase in the pulsatile index of PCA, VA and BA between NBD and NPSLE patients. The same results were obtained when comparing NBD versus controls. However, there was no significant difference between the NPSLE patients and the control group. The MRI lesions described were parenchymal lesions in 14 patients (46.7%), and vascular lesions in 4 patients (13.3%). Vascular lesions co-existed with parenchymal lesions (mixed lesion). Parenchymal lesions were in white matter (40%), thalamus (26.7%), brain stem (26.7%) and cerebellum (20%). While, in NPSLE, 23 patients were normal (92%) and only two patients had a vascular lesion (8%). Conclusion: There was a significant decrease in mean blood flow and a significant increase in the pulsatile index among both NBD and NPSLE patients, according to the TCD values.

4-hydroxy-2-nonenal as a marker of the oxidative stress in brains of dogs with canine distemper / 4-hidroxi-2-nonenal como marcador de estresse oxidativo no cérebro de cães com cinomose

Canine Distemper is a disease caused by Canine morbillivirus (CM), a pantropic virus that can affect the central nervous system (CNS), causing demyelination. However, the pathogenesis of this lesion remains to be clarified. Brain samples of 14 naturally infected dogs by CM were analyzed to evaluate the presence of oxidative stress and demyelination. RT-PCR assay was performed to confirm a diagnosis of canine distemper in the brain, immunohistochemistry anti-CM was used to localize the viral proteins in the tissue, and anti-4-hydroxy-2-nonenal (4-HNE) was a marker of a product of lipid peroxidation. The results showed the presence of viral proteins in the demyelinated area with the presence of 4-HNE. Our results suggest that the CM virus infection causes oxidative stress leading to lipid peroxidation, which causes tissue damage and demyelination. In conclusion, oxidative stress plays a significant role in canine distemper pathogenesis in the CNS.(AU)

A cinomose canina é uma doença causada pelo Morbilivírus canino (CM), um vírus pantrópico que pode afetar o sistema nervoso central (SNC), causando desmielinização. No entanto, a patogênese dessa lesão não está totalmente esclarecida. RT-PCR e imuno-histoquímica foram realizadas para confirmação do diagnóstico de cinomose em amostras de encéfalo de 14 cães naturalmente infectados. Após confirmação, foi realizada uma avaliação do estresse oxidativo por imuno-histoquímica com uso de anti-4-hidroxi-nonenal (4HNE) como marcador de produtos resultantes da peroxidação lipídica. Os resultados sugerem que a infecção pelo CM causa estresse oxidativo no tecido, levando a peroxidação lipídica, a qual causa danos ao tecido, culminando com desmielinização. Conclui-se que o estresse oxidativo tem papel importante na patogênese da cinomose canina no sistema nervoso central.(AU)

Pathogenic spectrum and laboratory indicators of fungal infections in the central nervous system / 中华预防医学杂志

Central nervous system (CNS) fungal infections are challenging and difficult to diagnose and treat. This article introduces the high risk factors, pathogen spectrum and laboratory indicators that cause CNS fungal infection. As patients with CNS fungal infections are often accompanied by immunodeficiency, it is especially necessary for clinical early detection, early prevention, and early diagnosis, and timely and effective implementation of optimized diagnosis and treatment programs to prevent further deterioration of the disease.

Diagnostic accuracy of the FilmArray™ Meningitis/Encephalitis panel in adult patients with suspected bacterial Meningitis in a tertiary care hospital in the Philippines

Objective@#Bacterial meningitis is associated with significant morbidity and mortality if not diagnosed and treated early. Isolation of the causative agent from cerebrospinal fluid culture is the gold standard for the diagnosis of this condition; however, it takes several days for results to be available. The FilmArray™ Meningitis/Encephalitis (ME) panel is a nucleic acid-based test that allows simultaneous detection of 14 bacterial, viral, and fungal pathogens in the cerebrospinal fluid with a rapid turnaround time. Our aim was to evaluate the diagnostic performance of the ME panel in detecting bacterial pathogens in the cerebrospinal fluid of adult patients with suspected bacterial meningitis in a tertiary hospital in the Philippines. @*Methods@#We performed a retrospective review of hospital records of adult patients with suspected bacterial meningitis who were admitted at our institution and underwent diagnostic testing with the FilmArray™ ME panel from January 1, 2018 to July 31, 2019. Overall percent agreement, sensitivity, and specificity for individual bacterial pathogens included in the panel were determined. @*Results@#A total of 88 cerebrospinal fluid samples were included in the analysis of diagnostic accuracy. The ME panel demonstrated 93.2% overall agreement, 50% sensitivity for E. coli, and 99–100% specificity in comparison with CSF culture in detecting bacterial pathogens that are included in the ME panel. @*Conclusion@#The results show that the FilmArray™ ME panel has high diagnostic accuracy and can be utilized in the rapid diagnosis and targeted treatment of patients with suspected bacterial meningitis.

Candidiasis invasora: un enfoque a la infección en el sistema nervioso central

Resumen La candidemia es la micosis invasora más frecuente en los pacientes internados en hospitales de alta complejidad en el mundo. La infección fúngica en el sistema nervioso central constituye una complicación potencialmente mortal que agrava el pronóstico de los pacientes. El presente artículo aborda aspectos relevantes sobre las características clínicas de esta enfermedad, los mecanismos de invasión del hongo, la respuesta inmunitaria local frente a Candida albicans y el impacto de los defectos genéticos en receptores de la inmunidad innata, que aumentan la susceptibilidad a la neurocandidiasis.

Infecciones del sistema nervioso central asociadas a dispositivos de derivación de LCR en niños, en un centro neuro-quirúrgico de referencia nacional / Central nervous system infections associated with CSF shunt devices in children, at a national reference hospital

INTRODUCCIÓN: Las infecciones asociadas a dispositivos de derivación de LCR son una complicación frecuente en su utilización. Lo más habitual es la presencia de cocáceas grampositivas, como Staphylococcus coagulasa negativa (50% en algunas series) y Staphylococcus aureus. Esta complicación agrega morbimortalidad al paciente neuroquirúrgico, aumentando la estadía hospitalaria y los costos de tratamiento. OBJETIVO: Conocer la incidencia de infecciones asociadas a dispositivos de derivación de LCR en un centro de referencia nacional. METODOLOGÍA: Estudio descriptivo, retrospectivo. Se recolectó la información de los pacientes pediátricos (bajo 18 años) entre 2018 y 2019. Se realizó un análisis estadístico descriptivo e inferencial utilizando el lenguaje estadístico R 3.4.0 y RStudio 1.3.9. Se calculó la incidencia acumulada para cada procedimiento, evaluando si existe diferencias significativas entre ellas. Estudio aprobado por el Comité de Ética Pediátrico del SSMO. RESULTADOS: En el período estudiado se realizaron 175 cirugías. Encontramos 19 casos de ventriculitis asociada a derivativa ventriculo-peritoneal y 7 casos en derivativa ventricular-externa. Los agentes más frecuentes fueron las cocáceas grampositivas. No se logró identificar factores de riesgo significativos.

BACKGROUND: Infections associated with CSF shunt devices are a frequent complication in their use. The most common is the presence of gram positive coccaceae, such as coagulase negative Staphylococcus (50% in some series) and Staphylococcus aureus. This complication adds morbidity and mortality to the neurosurgical patient, increasing hospital stay and treatment costs. AIM: To determine the incidence of infections associated with CSF shunt devices in a national referral center. METHODS: Retrospective, descriptive study. Information was collected on pediatric patients between 2018 and 2019. A descriptive and inferential statistical analysis was performed using the statistical language R 3.4.0 and RStudio 1.3.9. The cumulative incidence for each procedure was calculated, evaluating whether there were significant differences between them. This study was approved by the Pediatric Ethics Committee of the SSMO. RESULTS: In the period studied, 175 surgeries were performed. We found 19 cases of ventriculitis associated with ventriculoperitoneal derivative and 7 cases in ventricular-external derivative. The most frequent agents were grampositive coccaceae. It was not possible to identify significant risk factors.

Caracterización clínica de pacientes con infecciones del sistema nervioso central en un centro de atención terciaria / Clinical description of patients with central nervous system infections at a tertiary care center

Introducción: Las infecciones del sistema nervioso central constituyen un problema de salud a nivel mundial por la elevada morbimortalidad que produce. Objetivo: Caracterizar clínicamente a pacientes con infección del sistema nervioso central. Métodos: Estudio observacional, descriptivo y retrospectivo (2009-2018) en pacientes con infección del sistema nervioso central atendidos en el Hospital Hermanos Ameijeiras. Las variables estudiadas fueron: edad, sexo, tipo de infección, estado de inmunocompetencia, manifestaciones clínicas, complicaciones, agentes etiológicos, celularidad en el líquido cefalorraquídeo, estado al egreso, estadía hospitalaria. Resultados: Fueron incluidos 133 pacientes, 52,6 por ciento eran del sexo masculino y 45,9 por ciento tenían entre 40-59 años. Prevalecieron los pacientes con infecciones bacteriana en 58,6 por ciento, el staphylococcus sp fue el agente etiológico que más se identificó, la meningoencefalitis representó 36,8 por ciento, estaban inmunodeprimidos 56,4 por ciento, la cefalea y la fiebre estuvieron presente en 82,7 por ciento y la rigidez nucal en 15 por ciento. Las complicaciones respiratorias y la hidrocefalia representaron 21 por ciento y 12,8 por ciento respectivamente. El estado al egreso se asoció al estado de inmunocompetencia (p=0,002), la estadía hospitalaria (p=0,001) y el tipo de infección (p=0,002). Conclusiones: El principal tipo de infección según predominio de la celularidad fue la bacteriana, fue bajo el número de agentes etiológicos identificados. La meningoencefalitis fue la infección más frecuente. La cefalea, la fiebre y la rigidez nucal los síntomas y signos que predominaron, así como las complicaciones respiratorias y la hidrocefalia. Hubo asociación del estado al egreso con el tipo de infección, estado de inmunocompetencia y la estadía hospitalaria(AU)

Introduction: Central nervous system infections constitute a health problem worldwide due to the high morbidity and mortality that it produces. Objective: To clinically describe patients with central nervous system infection. Methods: An observational, descriptive and retrospective study was carried out from 2009 to 2018, in patients with central nervous system infection treated at Hermanos Ameijeiras Hospital. The variables studied were age, sex, type of infection, immunocompetence status, clinical manifestations, complications, etiological agents, cellularity in the cerebrospinal fluid, state at discharge, hospital stay. Results: One hundred thirty three patients were included, 52.6 percent were male and 45.9 percent aged between 40-59 years. Patients with bacterial infections prevailed in 58.6 percent, staphylococcus sp was the most identified etiological agent, meningoencephalitis accounted 36.8 percent, 56.4 percent were immunosuppressed, headache and fever were present in 82.7 percent and nuchal rigidity in 15 percent. Respiratory complications and hydrocephalus covered 21 percent and 12.8 percent respectively. Status at discharge was associated with immunocompetence status (p = 0.002), hospital stay (p = 0.001) and type of infection (p = 0.002). Conclusions: Bacterial infection was the main type of infection according to the cellularity predominance; the number of etiological agents identified was low. Meningoencephalitis was the most frequent infection. Headache, fever and nuchal stiffness were the predominant symptoms and signs, as well as respiratory complications and hydrocephalus. There was an association of the state at discharge with the type of infection, immunocompetence status and hospital stay(AU)

Cerebrospinal Fluid Infection with External Ventricular Drainage: Analysis of the Risk Factors in 110 Patients of a Single Institution

Objectives External ventricular drainage (EVD) is extensively used in the neurosurgical practice with the purpose of monitoring the intracranial pressure and draining the cerebrospinal fluid (CSF). Despite its remarkable benefits, the technique is not devoid of risks, notably infections, which have been reported in up to 45% of the cases. Methods A retrospective analysis of the main risk factors for CSF infection in neurosurgical patients submitted to EVD at a single institution. We recorded and submitted to statistical comparison every risk factor for CSF infection present or absent in each of the 110 EVD patients enrolled, 53 males and 57 females, with an average age of 52.9 years, with different underlying neurosurgical conditions. Results Infection of the CSF occurred in 32 patients (29%). The rate of mortality related to CSF infection was of 18.7% (6 of 32). The risk factors that showed statistical significance for CSF infection in this series were: emergency surgery; length of stay at the intensive care unit (UCI); duration of the EVD; parenchymal and/or intraventricular hemorrhage; simultaneous infections; time of bladder catheterization; and the use of non-disposable adhesive drapes as part of the preparation of the wound area. Conclusions Infection of the CSF in patients submitted to EVD is multifactorial and a challenge in terms of prevention. Further studies proposing scores with blended risk factors may be useful to prevent and reduce the morbidity and mortality associated with CSF infection.

Herpes simplex virus-1 encephalitis in a kidney transplant patient / Encefalitis por herpes simple tipo 1 en paciente con trasplante renal

Abstract The incidence of herpes simplex virus-1 (HSV-1) infection in kidney transplant patients is 3% in those who have received antiviral prophylaxis versus 9.8% without prophylaxis. Herpes viruses usually cause mucocutaneous lesions and only occasionally cause visceral disease or central nervous system infection in immunosuppressed and immunocompetent patients. The gold standard for diagnosis is DNA detection using polymerase chain reaction (PCR) in the affected organ. According to the literature, it is treated with acyclovir, with which remission is expected in most cases without sequelae. Here we present the clinical case of a kidney transplant patient who had HSV-1 encephalitis (with the virus detected in the cerebrospinal fluid (CSF) through PCR), and received the standard treatment with complete recovery of his neurological state. (Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).

Resumen La infección por herpes simple tipo 1 (HSV tipo 1) en los pacientes con trasplante renal tiene una incidencia de 3% en quienes han recibido profilaxis antiviral versus 9.8% sin profilaxis. Los virus herpes habitualmente producen lesiones mucocutáneas y sólo en ocasiones causan patología visceral o infección del sistema nervioso central en pacientes inmunosuprimidos e inmunocompetentes. La prueba de oro estándar para su diagnóstico es la detección del ADN mediante la reacción de cadena polimerasa (PCR) en el órgano afectado. El tratamiento de acuerdo con la literatura es con aciclovir, con el cual se espera una remisión de la enfermedad en la mayoría de los casos sin secuelas. A continuación, presentamos el caso clínico de un paciente con trasplante renal quien cursó con encefalitis por HSV tipo 1 detectado en líquido cefalorraquídeo (LCR) mediante PCR, quien recibió tratamiento estándar con recuperación completa de su estado neurológico.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1387).

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.

Utilidad de las técnicas de biología molecular en neuroinfecciones / Usefulness of molecular biology techniques in neuroinfectious diseases / Utilidade das técnicas de biologia molecular em neuroinfecções

Resumen: Introducción: un porcentaje de las infecciones del sistema nervioso central permanece sin diagnóstico etiológico. Las técnicas de amplificación de ácidos nucleicos mediante reacción en cadena de la polimerasa en tiempo real pueden disminuir este porcentaje. Objetivo: describir la etiología de las neuroinfecciones y valorar la utilidad de las técnicas de biología molecular en el diagnóstico y su impacto en el tratamiento antimicrobiano. Metodología: estudio observacional, descriptivo, retrospectivo a partir de registros clínicos. Se incluyeron mayores de 18 años asistidos en un hospital público de Montevideo durante un período de 32 meses, a quienes que se les realizaron técnicas de biología molecular en líquido cefalorraquídeo por sospecha clínica de neuroinfección. Resultados: se incluyeron 109 pacientes. En pacientes sin infección por VIH ni antecedentes neuroquirúrgicos (67%), se identificó microorganismo responsable en 16 casos, 8 bacterias y 9 virus. Todos identificados por técnicas de biología molecular modificando el tratamiento antimicrobiano empírico en 25 casos (34,2%). En portadores de VIH (25,7%), se detectaron microorganismos en 14 pacientes (50%). Seis virus, 5 bacterias y 7 hongos (Cryptococcus neoformans). El estudio por técnicas de biología molecular determinó el diagnóstico de 17 microorganismos y modificó el plan antimicrobiano inicial en 12 casos (42,9%). En pacientes con antecedente de neurocirugía reciente (7,3%), se aislaron seis microorganismos, tres de ellos exclusivamente mediante cultivo. Se modificó el tratamiento en tres casos (37,5%). Conclusiones: las técnicas de biología molecular deben considerarse complementarias. El impacto que generan en el diagnóstico y tratamiento justifica el uso de estas técnicas a pesar de su mayor costo.

Summary: Introduction: a certain percentage of infections of the central nervous system have no etiological diagnosis. Nucleic acids amplification techniques by means of a polymerase chain reaction in real time may reduce this percentage. Objective: to describe etiology of neuroinfectious diseases and assess the usefulness of molecular biology techniques in their diagnosis, as well as its impact on antimicrobial treatment. Method: observational, descriptive, retrospective study based on clinical records which included patients older than 18 years old, who had been assisted in a public hospital in Montevideo for over 32 months and had undergone molecular biology techniques with cerebrospinal fluid (CSF) given the clinical suspicion of neuroinfection. Results: 109 patients were included in the study. Among non-HIV infected patients who had not undergone neurosurgeries the responsible microorganism was identified in 16 cases (8 bacteria and 9 virus). They were all identified by molecular biology techniques by modifying the empiric antimicrobial therapy in 25 cases (34.2%). In carriers of HIV (25.7%), microorganisms were identified in 14 patients (50%). Six virus, 5 bacteria and 7 fungi (Cryptococcus neoformans). Molecular biology techniques defined the diagnosis of 17 microorganisms and modified the initial antimicrobial plan in 12 cases (42.9%). In patients with a history of recent neurosurgery (7.3%), 6 microorganisms were isolated, 3 of them exclusively through cultures. Treatment was modified in 3 cases (37.5%). Conclusions: molecular biology techniques need to be regarded as a complement. The impact that have in diagnosis and therapy justify their use despite its higher cost.

Resumo: Introdução: uma proporção das infecções do sistema nervoso central permanece sem diagnóstico etiológico. As técnicas de ampliação de ácidos nucléicos por reação em cadeia da polimerase em tempo real, podem diminuir esta proporção. Objetivo: descrever a etiologia das neuro infecções e avaliar a utilidade das técnicas de biologia molecular no diagnóstico e seu impacto no tratamento antimicrobiano. Metodologia: estudo observacional, descritivo, retrospectivo de prontuários de pacientes. Foram incluídos pacientes maiores de 18 anos, atendidos em um hospital público de Montevidéu, durante um período de 32 meses. Foram realizadas técnicas de biologia molecular ao líquido cefalorraquidiano por suspeita clínica de neuroinfecção. Resultados: foram incluídos 109 pacientes. Em pacientes sem infecção por VIH e sem antecedentes neurocirúrgicos (67%), o microrganismo responsável em 16 casos, sendo 8 bactérias e 9 vírus. Todos foram identificados por técnicas de biologia molecular modificando el tratamento antimicrobiano empírico em 25 casos (34,2%). Em portadores de VIH (25,7%), foram detectados microrganismos em 14 pacientes (50%). Seis vírus, 5 bactérias e 7 leveduras (Cryptococcus neoformans). O estudo por técnicas de biologia molecular permitiu o diagnóstico de 17 microrganismos e modificou o tratamento antimicrobiano inicial em 12 casos (42,9%). Em pacientes com antecedentes de neurocirurgia recente (7,3%), foram isolados 6 microrganismos, em 3 casos exclusivamente por cultura. O tratamento foi modificado em 3 casos (37,5%). Conclusões: as técnicas de biologia molecular devem ser consideradas como complementares. O impacto que causam sobre o diagnóstico e o tratamento justifica seu uso apesar de seu maior custo.

Intraventricular Vancomycin Therapy for Intractable Bacillus cereus Ventriculitis

Bacillus cereus causes serious central nervous system infections, especially in immunocompromised patients. Successful treatment requires adequate antimicrobial concentrations in the cerebrospinal fluid; however, in some cases, achieving this with systemic treatment alone is difficult. We treated intractable B. cereus ventriculitis with intraventricular vancomycin, with no major adverse events.

Primary Amebic Meningoencephalitis: A Case Report

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.

Cerebral Venous Sinus Thrombosis with Meningitis and Septicemia due to Haemophilus influenzae Type f in an Immunocompetent Child

Since the implementation of conjugate Haemophilus influenzae serotype b (Hib) vaccine, the rate of infections caused by Hib has dramatically decreased, and the proportion of infections caused by non-type b H. influenzae has increased. Cerebral venous sinus thrombosis (CVST) is rare; however, it should be considered as a potential complication of bacterial meningitis. Herein, we report about a child who developed CVST after being diagnosed with H. influenzae serotype f meningitis.

Infecciones en pacientes con tumores sólidos de sistema nervioso central y de cabeza y cuello / Infections in patients with solid tumors of the central nervous system and head and neck

Los tumores sólidos representan el 90% de las patologías oncohematológicas que se diagnostican en Argentina. Las infecciones son una de las complicaciones más frecuentes, causando una importante morbimortalidad, y en muchos casos retrasan la prosecución de los tratamientos específicos. La incidencia y tipo de infección depende del sitio específico del tumor, los fenómenos post obstructivos, el tipo e intensidad del tratamiento que se administre, las comorbilidades del paciente y la epidemiología local, entre otros factores. En forma constante se van incorporando nuevos tratamientos al arsenal terapéutico, tales como nuevos esquemas de quimioterapia, terapias blanco e inmunoterapia, y el manejo de las complicaciones asociadas a los mismos representa un desafío para el equipo tratante.En esta revisión abordamos la epidemiología, prevención y manejo de las complicaciones infecciosas más frecuentes en los pacientes con tumores de sistema nervioso central y de cabeza y cuello

Solid tumours represent 90 percent of the oncohematologic pathologies diagnosed in Argentina. Infections are one of the most frequent complications causing important morbidity and mortality and delay in prosecution of their specific treatment. The type of infection depends on the specific site of the tumour, the presence of post obstructive phenomena, the treatment administered, comorbidity and local epidemiology, among others. New therapies are being continuously incorporated to the armamentarium of cancer treatment such as new chemotherapies regimes, target therapy and immunotherapy. The management of adverse events and infectious complications associated with them are a challenge for the physician in charge of these patients.The epidemiology, prevention and management of the most frequent infectious complications in patients with tumours of the central nervous system and head and neck are reviewed in this paper

Roving Eye Movements in a Patient with Central Nervous System Infection

No abstract available.

Infección por Bartonella henselae con compromiso de sistema nervioso central, asociado a un papiloma del plexo coroídeo / Central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma

Resumen La infección por Bartonella henselae es una enfermedad prevalente en nuestro país. En general, se presenta como la enfermedad por arañazo de gato o un síndrome febril prolongado. Existen manifestaciones atípicas dentro de las cuales está el compromiso óseo, cardíaco, hepatoesplénico y del sistema nervioso central. Se presenta el caso de una adolescente con historia de vómitos, fiebre y ataxia, en que se diagnosticó una infección por Bartonella henselae con compromiso del sistema nervioso central, asociada a un papiloma del plexo coroídeo. Este caso corresponde a una presentación inusual, de difícil diagnóstico. Su tratamiento es motivo de controversia, tanto en si es necesario tratar, la elección del antimicrobiano, como su duración.

Bartonella henselae infection is a prevalent illness in Chile. It presents generally as a cat scratch disease or as a prolonged fever syndrome. There are atypical manifestations, which include central nervous system, bone, cardiac and hepato-esplenic compromised. We present an adolescent case with a history of fever, vomiting and ataxia, whose diagnosis was a central nervous system infection by Bartonella henselae associated with a choroid plexus papilloma. This case corresponds to an unusual presentation, with a challenging diagnosis. It is controversial whether to treat this patient, which antimicrobial is the right choice and how long the treatment should be.

Masa selar, no siempre un adenoma: presentación de 3 casos clínicos / A sellar mass, not always an adenoma: A report of 3 cases

El absceso hipofisario es un proceso infeccioso dentro de la silla turca, infrecuente, grave y de difícil diagnóstico debido a sintomatología variada e inespecífica. Presentamos 3 casos clínicos de abscesos hipofisarios, teniendo en común la presencia de lesiones preexistentes. Todos fueron intervenidos quirúrgicamente, 2 pacientes resultaron ser abscesos asépticos y en un paciente se aisló Aspergillus capsulatum. Presentaron buena evolución con el tratamiento médico pero con secuelas de hipopituitarismo. Es muy importante tener en cuenta el absceso hipofisario entre los diagnósticos diferenciales de las masas que se localicen en esa región debido a que el diagnóstico oportuno y el tratamiento correcto son relevantes para el pronóstico de estos pacientes.

Pituitary abscess is due to a severe and uncommon infection in the sella. It is difficult to diagnose due to varied and non-specific symptoms. A report is presented of 3 cases of pituitary abscess, which had the presence of pre-existing injuries in common. All were subjected to surgery, with aseptic abscesses found in 2 patients, and Aspergillus capsulatum was isolated in 1 patient. They showed good progress with medical treatment, but with sequelae of hypopituitarism. It is very important to consider the pituitary abscess in the differential diagnosis of the masses that are located in that region, as a timely diagnosis and proper treatment can be important for the prognosis of these patients.