Subject(s)
Eye Infections, Viral/drug therapy , Hemorrhagic Fever, Ebola/drug therapy , Iris Diseases/drug therapy , Panuveitis/drug therapy , Pigmentation Disorders/drug therapy , Administration, Oral , Adult , Amides/therapeutic use , Atropine/therapeutic use , Drug Combinations , Ebolavirus/genetics , Ebolavirus/isolation & purification , Eye Infections, Viral/diagnosis , Eye Infections, Viral/virology , Fluprednisolone/analogs & derivatives , Fluprednisolone/therapeutic use , Glucocorticoids/therapeutic use , Hemorrhagic Fever, Ebola/diagnosis , Hemorrhagic Fever, Ebola/virology , Humans , Injections, Intraocular , Iris Diseases/diagnosis , Iris Diseases/virology , Male , Microscopy, Acoustic , Multimodal Imaging , Mydriatics/therapeutic use , Ophthalmic Solutions , Panuveitis/diagnosis , Panuveitis/virology , Pigmentation Disorders/diagnosis , Pigmentation Disorders/virology , Prednisone/therapeutic use , Pyrazines/therapeutic use , RNA, Viral/genetics , Real-Time Polymerase Chain Reaction , Survivors , Triamcinolone Acetonide/therapeutic use , Vitreous Body/virologyABSTRACT
Infections due to Pseudomonas fulva remain a rare but emerging concern. A case of ventriculitis due to Enterobacter cloacae and Pseudomonas fulva following placement of an external ventricular drain is described. Similar to other reports, the organism was initially misidentified as Pseudomonas putida. The infection was successfully treated with levofloxacin.
Subject(s)
Cerebral Ventriculitis/diagnosis , Cerebral Ventriculitis/microbiology , Coinfection/diagnosis , Coinfection/microbiology , Pseudomonas putida/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cerebral Ventriculitis/drug therapy , Coinfection/drug therapy , Enterobacter cloacae/isolation & purification , Female , Humans , Levofloxacin/therapeutic use , Microbiological Techniques , Middle Aged , Treatment OutcomeABSTRACT
Cryptococcal meningitis is the most common cause of adult meningitis in Africa, yet neurocognitive outcomes are unknown. We investigated the incidence and predictors of neurologic impairment among cryptococcal survivors. HIV-infected, antiretroviral-naive Ugandans with cryptococcal meningitis underwent standardized neuropsychological testing at 1, 3, 6, and 12 months. A quantitative neurocognitive performance z-score (QNPZ) was calculated based on population z-scores from HIV-negative Ugandans (n = 100). Comparison was made with an HIV-infected, non-meningitis cohort (n = 110). Among 78 cryptococcal meningitis survivors with median CD4 count of 13 cells/µL (interquartile range: 6-44), decreased global cognitive function occurred through 12 months compared with the HIV-infected, non-cryptococcosis cohort (QNPZ-6 at 12 months, P = 0.036). Tests of performance in eight cognitive domains was impaired 1 month after cryptococcal diagnosis; however, cryptococcal meningitis survivors improved their global neurocognitive function over 12 months with residual impairment (mean z-scores < -1), only in domains of motor speed, gross motor and executive function at 12 months. There was no evidence that neurocognitive outcome was associated with initial demographics, HIV parameters, or meningitis severity. Paradoxically, persons with sterile CSF cultures after 14 days of induction amphotericin therapy had worse neurocognitive outcomes than those still culture-positive at 14 days (P = 0.002). Cryptococcal meningitis survivors have significant short-term neurocognitive impairment with marked improvement over the first 12 months. Few characteristics related to severity of cryptococcosis, including Cryptococcus burden, were associated with neurocognitive outcome.
