Normal cerebrospinal fluid values in full-term gestation and premature neonates.

Results of cerebrospinal fluid (CSF) examinations from 77 high-risk neonates were reviewed. The mean CSF white cells (WBC) count was 4.5 cell/mm3, being two standard deviations above the mean 11.7 cells/mm3 in the full-term gestation neonate group; in the premature neonate one, the mean CSF WBC count was 5.1 cells/mm3, being two standard deviations above the mean 16.7 cell/mm3. PMNs (polymorphonuclear leukocytes) were present in less than 40% of those children, being the mean PMN percentage 4.2% and 0.6%, the mean ANC (absolute neutrophil count) was 0.3/mm3 and 0.06/mm3, in full-term gestation neonate group and premature neonate one, respectively. The mean CSF protein concentration is significantly greater in those premature neonates (101.2 mg/dl) compared with that in term neonates (77.6 mg/dl). The average glucose was just the same in both groups (67 mg/dl). All of these values were from patients who underwent nontraumatic cisternal puncture, with no red blood cells (RBC/mm3 = 0). Traumatic puncture, even up to 500 RBC/mm3, interfered on CSF parameters.

[Etiology of bacterial meningitis in a cohort from Salvador, Bahia]. / Etiologia de meningites bacterianas em uma amostra da população de Salvador-Bahia.

Bacterial meningitis remains a very important disease world-wide, mainly during childhood. In order to describe the etiology of bacterial meningitis among some children in Salvador, Bahia-Brazil, we retrospectively reviewed 7000 cerebrospinal fluid exams, performed within the period of September 1988 up to August 1995, at the CSF Laboratory, José Silveira Foundation; 892(12.7%) exams met the inclusion criteria; patients less than 16 years of age and clinical meningitis diagnosis. Among 139 cases of bacterial meningitis, H. influenzae type b (Hib) was the most frequent cause (26.0%), all of the cases in children under 5 years. We have been questioning whether the declining Hib disease trend since 1992 has been associated with the use of Hib conjugate vaccines among those children.

[Mansonic neuroschistosomiasis: clinical, laboratory and therapeutic aspects]. / Neuroesquistossomose mansônica: aspectos clínicos, laboratoriais e terapêuticos.

The authors report 16 patients bearing the meningomyeloradicular form of Mansonic neuroschistosomiasis diagnosed according to clinical, laboratorial and image criteria. Patients have been observed at the Neurology Ambulatory of the Federal University of Bahia, within the period of April/91 to December/93. They have been treated with praziquantel, associated to corticosteroids. The aim has been to evaluate the drug's efficiency and safety in decreasing the neurological signs and symptoms.

HTLV-I associated tropical spastic paraparesis. Cerebral spinal fluid evolutive aspects in 128 cases.

In order to evaluate if there is variation on the intensity of cerebral spinal fluid (CSF) response during HTLV-I associated tropical spastic paraparesis (TSP) evolution we retrospectively reviewed 128 cases. The results indicate that although CSF inflammatory alterations can persist over a 10-year period, they tend to become slight or even absent after the second year of TSP evolution.

Lymphomatous meningoencephalitis in a patient with HAM/TSP.

A case of lymphomatous meningoencephalitis in a 23 year old Brazilian patient with HTLV-I/II associated myelopathy is reported. The patient was admitted to the hospital with a clinical picture of decreased consciousness level, stiffness of the neck and previous diagnosis of myeloneuropathy. CSF examination showed lymphocytosis with blastic cells and antibodies against HTLV-I/II.

Neurocriptococose por Cryptococcus neoformans näo capsulado / Neurocryptococcosis due to non capsulated Cryptococcus neoformans

Os autores registram um caso de neurocriptococose em paciente HIV-positivo, por Cryptococcus neofarmans acapsulado ou deficiente em cápsula. O quadro neurológico era de meningoencefalite subaguda, compatível ao diagnóstico de neurotuberculose, pelo exame do líquido cefalorraqueano (LCR). Estruturas leveduriformes foram encontradas no interior de macrófagos, ao exame citomorfológico do LCR. Cultivo do sedimento do LCR revelou a presença de Cryptococcus neoformans näo capsulado (identificaçäo bioquímica). A inoculaçäo da amostra em camundongo, por via intraperitoneal, permitiu a produçäo de cápsula que desaparecia em cultivos. Foi estudada a micromorfologia do fungo à microscopia eletrônica de varredura. A evoluçäo foi favorável com o emprego da anfotericina B associada a 5-fluoreocitosina. Näo foi caracterizada a variedade de Criptococcus neoformans agente do processo

[Neurocryptococcosis caused by nonencapsulated Cryptococcus neoformans]. / Neurocriptococose por Cryptococcus neoformans não capsulado.

The case of a patient with meningoencephafalitis due to a nonencapsulated strain of Cryptococcus neoformans is reported; he had no risk factors for the disease or AIDS. Clinical examination showed a chronic meningoencephalitis first diagnosed as tuberculosis. In the second cerebrospinal fluid (CSF) examination after a week from admission yeasts appeared inside macrophage cells. CSF culture in Sabouraud medium disclosed nonencapsulated Cryptococcus neoformans (biochemical identification). Sample inoculation in mouse (intraperitoneal) evidenced a capsule that disappeared in several consecutive cultures. The morphology of the yeast was studied by electronic microscopy. After treatment with amphotericin B and 5-fluorocytosine the patient had a favorable evolution. The significance of capsular material is discussed.

Evidence of preferential female prevalence of HTLV-I associated tropical spastic paraparesis in Bahia-Brazil.

In order to evaluate the prevalence of HTLV-I infection and its association with tropical spastic paraparesis (TSP) in Bahia, a Northeastern State of Brazil, CSF and sera from TSP patients and CSF and/or sera from some selected groups of individuals were studied. The results seem to indicate a higher prevalence of HTLV-I infection in women than men with TSP and among individuals of HIV risk groups. Some alterations of routine analysis of CSF can suggest HTLV-I infection in TSP patients.

HTLV-I associated myelopathy in Salvador (northeastern Brazil).

Recent studies of tropical spastic paraparesis have confirmed the existence of human T-cell leukemia virus type-1 (HTLV-I) in several tropical areas of the world. In order to determine the role of HTLV-I as an etiologic agent of myelopathies in Salvador, we conducted a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. We found 9 patients with HTLV-I associated myelopathy (HAM) which points to a new endemic area of HAM.

PIP: Human T-lymphotropic virus type one (HTLV-I) exists in several tropical areas of the world and is associated with adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-I associated myelopathy (HAM) has been described in southern Japan, the US, Colombia, and Central Africa. Several cases have also been identified and described in Brazil. The authors describe the first cases of HAM in Bahia based upon a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. Sera and CSF of the 43 patients admitted to a general hospital in Salvador over the course of six months with chronic spastic paraparesis were tested for HTLV-I, of whom nine with progressive chronic spastic paraparesis had serum and CSF positive to HTLV-I. These patients were aged 18-56 years. Two were promiscuous and one of them had a blood transfusion eight months before symptoms. They had similar histories with progressive weakness, first in one leg and after in the other which was associated with paresthesias in varying degrees of intensity. None of the patients had sensory level, although all had vegetative disturbances which were characterized by bladder dysfunction, constipation, and impotence in men. These findings suggest the existence of a new area in which HAM is endemic.

[Cerebrospinal fluid in infection of the central nervous system by yeasts of the genus Candida: analysis of 11 cases]. / Líquido cefalorraqueano em infecção do sistema nervoso central por leveduras do gênero Candida análise de 11 casos.

This study is based on the analysis of 44 cerebrospinal fluid (CSF) samples from 11 patients with central nervous system (CNS) Candida infection. Risk factors for CNS fungal infection were present in all patients. Five had a chronic meningitis syndrome; two had acquired immunodeficiency syndrome (AIDS); two had cranial trauma followed by chronic meningities; one had intravascular disseminated coagulation syndrome and sepsis; and one had systemic candidiasis after kidney transplant. Etiological diagnosis was made in all by the CSF examination. Nine cases had positive CSF culture for Candida. Two patients presented the yeast in the direct examination, and one of them had reagent complement fixation test for Candida in three successive samples of CSF. Changes found in the CSF composition are discussed in order to evaluate the inflammatory response to CNS infection by Candida.

[Latex agglutination tests of the cerebrospinal fluid in bacterial meningitis: an analysis of 333 cases]. / Provas de aglutinação do látex no líquido cefalorraqueano em meningites bacterianas: análise de 333 casos.

The study is based on 333 cerebrospinal fluid (CSF) samples from patients with clinical diagnosis of acute bacterial meningites. The aim of the study is a critical evaluation on latex agglutination tests in CSF for H. influenzae type b, N. meningitidis A and C, and S. pneumoniae. These tests are compared with direct examination (Gram method), and culture results. It was shown that results of the latex test in the CSF are basic for rapid diagnosis of etiological agent in a bacterial meningitis. Data on 106 CSF samples confirmed the etiology through latex tests in 98.2% for H. influenzae type b, in 15.8% for N. meningitidis A or C, in 96.8% for S. pneumoniae. Emphasis is given for evidence of antibiotic therapy previous to CSF collection, which may be responsible for the great number of negative results registered in the present series.