[20 years' therapy with high doses of chloramphenicol in bacterial inflammations of the meninges]. / Dvacet let lécení vysokými dávkami chloramfenikolu u bakteriálních zánetu mozkových blan.

The authors present their experience with the treatment of bacterial meningitis with large doses of chloramphenicol (200 mg/kg body weight per day by the i.v. route in three doses) in bacterial meningitis caused by common agents (i.e. Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis). They discuss the toxicity of chloramphenicol, complications, draw attention to contraindication of treatment with large doses. Treatment of bacterial meningitis with large doses of chloramphenicol is safe, if controlled as described. This is confirmed also by authors abroad. Cephalosporins of the third generation are indicated above all in bacterial meningitis caused by Gram-negative microorganisms.

Ceftriaxon in treatment of bacterial meningitis.

The authors tested cephalosporin antibiotic of the 3rd generation--Ceftriaxon--in treatment of bacterial meningitis. After studying the infiltration of the antibiotic into the cerebrospinal fluid in 13 patients with parotitic meningoencephalitis, the authors treated 15 patients with bacterial meningitis. Ceftriaxon has been applied in 100 mg/kg in two doses i.v. The research antibiotic levels in cerebrospinal fluid varied from 10 to 30% of sera levels and were much higher than MIC for pathogens isolated from liquor. The treatment effects were very good the dropping of temperature followed on the 3-4 day, the 5-6, day under 100/3. The side effects showed a short time increasing of transaminases and diarrhoea. After completing the treatment normalisation occurred quickly. Other side effects have not occurred. The authors can state, Ceftriaxon in treatment of bacterial meningitis is a highly effective antibiotic.

The Slidex-meningite-Kit (Bio-Merieux) tested for exoantigen detection in spinal fluids from purulent meningitis cases.

The Slidex-méningite-Kit allows the used of the rather highly sensitive and specific latex-agglutination method for the detection of N. meningitis group A and C and H. influenzae b exoantigens within a few minutes. In model experiments positive results persisted at unchanged intensity for prolonged periods of time regardless of storage temperature. However, in practical trials performed in a set of 60 spinal fluids from purulent meningitis patients etiological agent identification by the slidex-méningite-Kit failed at least as frequently as by cultivation; in the case of meningococci the kit even failed more often than cultivation. Hence the Slidex-méningite-Kit should be regarded as an auxiliary tool in the diagnosis of purulent meningitis and one that cannot replace the classical methods of cultivation and preparation staining. In the case of positive results, advantages of the Slides-méingite-Kit are rapidity in etiological agent identification and prolonged persistence of positivity in the spinal fluid samples.

[Schematic principles in the therapy of bacterial inflammation of the brain and meninges]. / Schematische Grundsätze der Therapie von bakteriellen Hirn- und Hirnhautentzündungen.

Bacterial diseases of the central nervous system develop per continuitatem of haematogenically. Each of these two groups can further be subdivided. As an initial therapy when an unknown agent is present chloramphenicol in high doses (200 mg/kg KM) stood the test for adults and older children and ampicillin (200 to 400 mg/kg KM), respectively, for babies and infants. In case of need, this therapy is correlated according to the findings of the culture and the antibiogramme. In secondary meningitides the surgical cure of the focus should be performed only after improvement of the general condition. Recidivating meningitides undergo an operation when liquor fistulae are proved. In an unclarified cause a long-term therapy with oxacillin or lincomycin over 3-6 months is possible. In the meningitis of newborn the combination of ampicillin, carbenicillin or colistin with gentamycin is necessary, intravenously and intrathecally. Hydrocortisone and streptokinase shall prevent the transfer of the liquor spaces. Of great importance is the combat against the cerebral oedema. In mycetogenous meningitis amphotericin B, eventually in combination with 5-fluorocytosine, can be used. There are still no effective remedies against the amoebic meningo-encephalitis.

Rapid diagnosis of tick - borne encephalitis by immunofluorescence assay of specific serum IgM antibodies.

The indirect IF technique, using suspensions of TBE virus infected and uninfected PS cells as antigen-containing substrate, furnishes a rapid and practical test making possible the detection of specific IgM class serum antibodies in the initial stage of clinically manifest TBE. It enables early confirmation of diagnosis already in the acute phase of the disease and thus it can be instrumental in differential diagnosis and rational therapy, e.g., the administration of specific hyperimmune gamma-globulin.

[Clinical picture of Central European tick-borne encephalitis (author's transl)]. / Klinisches Bild der Zentraleuropäischen Zeckenenzephalitis

Tick-borne encephalitis is transmitted by the tick ixodes ricinus. After the second world war an increase in the number of cases of encephalitis was observed and the neurotropic virus was isolated for the first time in 1948. Reservoir animals are mouse-like wild animals and also agricultural domestic animals. The infection is transmitted to humans through tick bites. It becomes apparent subjectively in headaches, vomiting, tiredness, giddiness and insomnia, and objectively in meningeal symptoms, extrapyramidal tremor, cerebellar ataxia, vestibular nystagmus and paresis. The treatment consists of strict rest in bed for 10 days at least and symptomatic support of the general health. Good results are obtained with antiedematous therapy with hydrocortisone or pyritinol.