ABSTRACT
BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude. CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis. CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.
Subject(s)
Interferon-alpha/cerebrospinal fluid , Meningitis, Aseptic/diagnosis , Amoxicillin/pharmacokinetics , Amoxicillin/therapeutic use , Breast Feeding , Humans , Infant , Male , Meningitis, Aseptic/drug therapy , Milk, Human/microbiology , Penicillins/pharmacokinetics , Penicillins/therapeutic useABSTRACT
We studied a group of African immigrant, living in France with HIV and we report oral and facial manifestations observed among them.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Emigration and Immigration , Face , HIV Infections/complications , Mouth Diseases/complications , AIDS-Related Opportunistic Infections/complications , Acquired Immunodeficiency Syndrome/diagnosis , Adult , Africa/ethnology , Candidiasis, Oral/complications , Female , HIV Infections/diagnosis , HIV Seropositivity/diagnosis , Humans , Incidence , Lymphadenitis/complications , Male , Marital Status , Middle Aged , ParisABSTRACT
We report a case of a cyst of maxillary in a patient suffering from sickle-cell anemia. A review of literature and therapeutic management is exposed.
