Cryptococcal meningoencephalitis diagnosed by blood culture.

Increase in cryptococcal infection has been noticed after acquired immunodeficiency syndrome pandemic. Cryptococcus neoformans can be isolated from blood in the process of dissemination to brain. We report a case of cryptococcal fungaemia in a patient whose cerebrospinal fluid was negative for Cryptococcus neoformans. Retrospective analysis revealed human immunodeficiency virus seropositivity of the patient. He was treated with amphotericin B and fluconazole. Antiretroviral therapy was started, however, the patient succumbed to the infection.

sICAM-1 in meningoencephalitis due to Angiostrongylus cantonensis / sICAM-1 en meningoencefalitis por Angiostrongylus cantonensis

INTRODUCTION: Angiostrongylus cantonensis meningoencephalitis is an emergent disease in the Americas. METHOD: Twelve children suffering from eosinophilic meningoencephalitis due to this parasite aged between 6-10 years were studied. Cerebrospinal fluid (CSF) and serum samples were taken simultaneously in the first diagnostic puncture at admission. RESULTS: All cases showed typical findings on the routine CSF and serum analysis: increased CSF total protein, increased Q (CSF/serum) albumin accompanied by eosinophilia in CSF. No intrathecal synthesis of immunoglobulins was found. Mean serum and CSF sICAM-1 values were 337.4 and 3.97 ng/mL. Qalbumin and QsICAM-1 mean values were 4.1 and 6.2 respectively. In 50 percent of the patients an increased brain-derived fraction of sICAM-1 was found. CONCLUSION: It may be suggested that a dynamic of the sICAM-1 brain derived fraction is perhaps associated to the immune response in the evolution of the disease.sICAM-1 may be an agent in negative feedback for eosinophils passage through the blood-CSF barrier into the inflammatory brain response.

INTRODUCCION: La meningoencefalitis por Angiostrongylus cantonensis es una enfermedad emergente en las Américas. MÉTODO: Doce niños con meningoencefalitis eosinofílica por Angiostrongylus cantonensis con edades entre 6 y 10 años fueron estudiados. Se tomaron muestras simultáneas de suero y líquido cefalorraquídeo (LCR) en la primera punción lumbar diagnóstica. RESULTADOS: Todos los casos evidenciaron hallazgos típicos en los análisis de rutina del LCR y suero: incremento de proteínas totales, aumento de la razón albúmina Q (LCR/suero) acompañado de eosinofilia en LCR. No se encontró síntesis intratecal de inmunoglobulinas. Los valores medios de sICAM-1 en suero y LCR fueron de 337,4 y 3,97 ng/mL respectivamente. Los valores medios de Q albúmina y Q sICAM-1 fueron de 4,1 y 6,2 respectivamente. En el 50 por ciento de los pacientes se encontró un incremento de la fracción de sICAM-1 derivado del cerebro. CONCLUSION: Se puede sugerir que la dinámica de la fracción sICAM-1 derivada del cerebro ocurre quizas asociada a la respuesta inmune frente a la enfermedad. sICAM-1 puede ser un agente de retroalimentación negativa para el paso de eosinófilos de la sangre a través de la barrera sangre-LCR en el cerebro inflamado.

Acid base status and IgG index in viral meningoencephalitis: diagnostic and prognostic aspects

The current study was carried out on 182 patients with viral encephalitis or meningoencephalitis being selected according to certain clinical as well as C.S.F. criteria in which the viral etiology could be confirmed in 118 cases of them through various virus identification techniques. The aim of the study was to evaluate from the diagnostic as well as prognostic point of view various pH and gases changes in the CSF as well as arterial blood in those patients and in addition to assess the intrathecal IgG production which was reported to increase in those patients. In order to get reliable data, the study included 20 healthy subjects as a control group who were subjected to all lab tests as the patient's group including: CSF and blood pH PO[2] PCo[2] and also a simple equation for determining IgG index as an indicative for intrathecal IgG production. The results showed highly significant reduction in blood PCO2, PO[2] and CSF pH, PO[2], associated with a highly significant elevation in blood pH and CSF PCO[2] in patients compared to control group. Prognostically speaking, the changes in the above mentioned variables, with the exception of blood pH and CSF PO[2] could reflect the clinical severity with an intimate relation to the final outcome. However, no statistical relationship; could be found between these variables and the various etiological viruses. Regarding the IgG index, elevated figures, i.e. > 0.7 were reported in most of the patients [around 84 percent] while all individuals within the control group showed values less than 0.7. However, local IgG production was unreliable test for predicting the outcome, din cal severity and viral etiology where the difference between IgG index values among different outcomes, clinical severity and virals etiology parameters were statistically insignificant

Síntesis intratecal de inmunoglobulinas en meningoencefalitis producida por Angiostrongylus Cantonensis (Chen, 1935) / Intrathecal synthesis of immunoglobulins in meningoencephalitis caused by Angiostrongylus Cantonensis (Chen, 1935)

Se estudiaron 4 casos de meningoencefalitis eosinofílica producida por Angiostrongylus cantonensis. Se encontró en el estudio citoquímico del líquido cefalorraquídeo de estos pacientes, un predominio de eosinófilos con IgE aumentada. En el suero hubo un comportamiento variable de las inmunoglobulinas a excepción del aumento de la IgE total. Hubo síntesis de IgG e Iga en todos los pacientes y síntesis de IgM en uno de ellos. El tanto por ciento de síntesis intratecal fue variable y la síntesis de IgE se manifiesta en 2 tendencias con igual número de casos

Determinación de cortisol plasmático en pacientes con enfermedad meningocóccica / Determination of plasma cortisol in patients with meningococcal disease

Se estudiaron 20 niños de tres meses a 14 años de edad, con diagnóstico confirmado de enfermedad meningocóccica (ocho pacientes con meningococemia y 12 con meningoencefalitis meningocóccica), incluyendo tres fallecidos. A todos se les determinó el nivel de cortisol en sangre antes de recibir tratamiento alguno, mediante el método de radioinmunoensayo. Ningún paciente presento una cifra inferior a la normal. Un niño tuvo cifras normales y el resto las presentó elevadas. No existió relación estadísticamente significativa entre las cifras basales de cortisol, la forma clínica, ni la presencia de shock. La función adrenal un mes más tarde no estaba normalizada pues algunos pacientes mantuvieron cifras basales altas. Estos resultados concuerdan con el criterio de que no hay insuficiencia suprarrenal en estos pacientes durante la fase aguda