ABSTRACT
Cryptococcal meningitis is a life-threatening disease. Headache, vomiting, cranial nerve symptoms and mental changes are the most common symptoms, but as many as 15% may have no symptoms referable to the CNS. For chemotherapy four drugs are available: namely amphotericin B, 5-fluorocytosine, miconazole and ketoconazole. Most cases have been treated by combination of amphotericin B and 5-fluorocytosine. The intrathecal administration of amphotericin B should be considered for patients who fail to respond to the usual intravenous therapy. The case is reported of a patient who died due to hydrocephalus, and the CSF-levels of the administered drugs are presented. Some pitfalls of therapy are discussed.
Subject(s)
Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy , Meningitis/drug therapy , Adult , Amphotericin B/therapeutic use , Cryptococcosis/diagnosis , Drug Resistance, Microbial , Drug Therapy, Combination , Flucytosine/therapeutic use , Humans , Injections, Intraventricular , Male , Meningitis/diagnosis , RecurrenceSubject(s)
Encephalitis, Arbovirus/etiology , Herpesviridae Infections/complications , Influenza, Human/complications , Acute Disease , Adolescent , Antibodies, Viral , Complement Fixation Tests , Diagnosis, Differential , Electroencephalography , Encephalitis, Arbovirus/microbiology , Herpesviridae Infections/microbiology , Humans , Influenza A virus , Influenza, Human/microbiology , Male , Serologic Tests , SimplexvirusABSTRACT
An atypical case of amyotrophic lateral sclerosis (ALS) is described, characterized by early manifestation, a long lasting course with asymmetry of the lesions, absence of bulbar symptoms in the presence of an otherwise very advanced symptomatology, and constant signs of an inflammatory reaction in the CSF which was the reason to initiate extensive virological studies, including procedures for virus isolation. A virus belonging to the TbE complex of arbovirus group B (tick-borne flavivures), was finally isolated from the CSF. About 70% of the ALS cases in Hamburg/W. Germany, examined for antibodies, apparently had contact with this virus. The antibody pattern found made it possible to explain this exceptional case.
Subject(s)
Amyotrophic Lateral Sclerosis/microbiology , Cerebrospinal Fluid/microbiology , Encephalitis Viruses, Tick-Borne/isolation & purification , Adult , Amyotrophic Lateral Sclerosis/cerebrospinal fluid , Amyotrophic Lateral Sclerosis/physiopathology , Animals , Antibodies, Viral/analysis , Cell Count , Cerebrospinal Fluid/cytology , Cerebrospinal Fluid Proteins/analysis , Cross Reactions , Encephalitis Viruses, Tick-Borne/immunology , Humans , Lymphocytes/pathology , Male , Mice , Neutralization TestsABSTRACT
1. This report is concerned with 44 cases of acute viral encephalitides which were seen in the eight-year period 1965-72. 2. There is a significant difference in sex distribution: 63% males and 37% females. Nearly two-thirds of our patients were aged up to 30 years. There is no seasonal accumulation of incidence of the sporadic encephalitides. 3. The clinical diagnosis was based on "influenza-like" preliminary symptoms (25 patients), acute onset of neurological symptoms (30 patients) with signs of cerebral alterations like headache, drowsiness, confusion and epilepsy (22 patients), partly focal neurological signs (14 patients), inflammatory cerebro-spinal fluid alterations (36 patients) and other virus caused simultaneous diseases like myocarditis, hepatitis, pneumonia and exanthemata (19 patients). Alterations of blood sedimentation rate, number of white or red blood cells and differential blood count have no bearing on rapid diagnosis of acute viral encephalitides. Results of usual virological examinations often come to late for early diagnosis. Neuro-radiological procedures and isotope encephalography cannot help to get diagnosis in the initialphase of encephalitis. 4. 6 patients died, 5 had residual neurological deficit. 33 patients recovered completely though they partly had severe encephalitides. 5. There is no spezific treatment of acute viral encephalitides. Application of cortisone and antipyretic drugs is not indicated. 6. Most of the viral encephalitides may be classified when an extensive virological examination will be carried out.
