ABSTRACT
A 46-year-old woman was admitted for a four-month history of progressive cognitive and behavioral disorders. MRI revealed hydrocephalus with meningeal enhancement after gadolinium infusion. The lumbar puncture found a purulent CSF containing 305 nucleate elements per cubic millimeter including 84% altered polymorphonuclear neutrophils, protein at 4.88 g/L, and glucose at 0.5 mmol/L (for a glycemia at 6 mmol/L); there was no germ on direct examination. High dose IV cefotaxime was started together with anti-tuberculous treatment. After nine days CSF cultures were positive for Neisseria meningitidis group B. The patient improved dramatically. Only three cases of chronic N. meningitidis meningitis have been previously reported in the literature. It is important to recall that the clinical presentation of N. meningitis can be misleading, sometimes pseudo-psychiatric, without frank infectious syndrome, and may follow a chronic course.
Subject(s)
Meningitis, Meningococcal/cerebrospinal fluid , Meningitis, Meningococcal/psychology , Antitubercular Agents/therapeutic use , Cerebral Ventricles/pathology , Chronic Disease , Female , Humans , Magnetic Resonance Imaging , Meningitis, Meningococcal/pathology , Middle Aged , Neisseria meningitidis, Serogroup B , Neuropsychological Tests , Treatment OutcomeABSTRACT
INTRODUCTION: Contrary to patients exhibiting cellular immunodepression, legionellosis is rare in HIV-infected patients. We report 4 cases. OBSERVATIONS: Four men aged 41 to 48 were infected by HIV-1. Three of them were treated with antiretroviral therapy. The clinical and biological manifestations were unspecific. Evolution was favourable with adapted antibiotic therapy (erythromycine for three patients and ciprofloxacine for the fourth). COMMENTS: Legionella pneumophila serotype Lp1 remains the principle etiological agent. Frequent use of contrimoxazole in prophylaxis against pneumocystosis and toxoplasmosis, macrolides, rifamycines and fluoroquinolones in the preventive and curative treatment of mycobacterioses, and the relative conservation of monocyte/macrophage function and immune repair with efficient antiretroviral therapy, may explain the low prevalence of this disease in HIV infections.
