Drug-induced aseptic meningitis in suspected central nervous system infections.

This study presents eight patients with drug-induced aseptic meningitis (DIAM) admitted to our centre with an initial suspicion of central nervous system (CNS) infection. In all patients clinical findings, cerebrospinal fluid (CSF) examination, a cause-effect relationship according to the Naranjo adverse drug reactions probability scale and other diagnostic criteria required for DIAM recognition, were fulfilled. Nonsteroidal anti-inflammatory drugs were the most frequent cause of DIAM. In two cases, there was previous antimicrobial use. The time between use of the causative drug and onset of the symptoms ranged from 2 to 7 days. Clinical symptoms and CSF findings in patients with DIAM are indistinguishable from the early stage of infections of the CNS. Detailed anamnesis is essential, particularly related to medication use immediately prior to the appearance of symptoms of CNS impairment. In conclusion, the differential diagnosis of CNS infections should include DIAM.

[Hepatocytes growth factor (HGF), leptin, neopterin serum concentrations in patients with chronic hepatitis C]. / Stezenie czynnika wzrostu hepatocytów (HGF), leptyny i neopteryny w surowicy chorych na przewlekle wzw typu C.

UNLABELLED: In 18 patients with chronic hepatitis C we evaluated leptin (with IRMA method) and HGF and neopterin (with ELISA method) serum concentrations. Concentrations of leptin, HGF and neopterin were higher than in the control group. Leptin serum concentrations correlated with liver biopsy inflammatory grading, but higher HGF concentrations were connected with fibrosis staging. Neopterin correlated with both parameters and GGTP activity. IN CONCLUSION: increased neopterin concentrations could inform about liver inflammation activity; leptin and HGF serum concentrations could reflect the liver damage intensity.

Epidemiology of hepatitis C virus infections in children.

BACKGROUND: Epidemiological analysis of hepatitis C virus infections in children diagnosed and treated in the Hepatology Outpatient Clinic in Bytom between 1996 and 1999. MATERIAL AND METHODS: The study comprised 62 children with detected serum presence of anti-HCV antibodies (ELISA method) and/or HCV-RNA (RT-PCR method). Risk factors for the infection were thoroughly analysed on the base of questionnaires. RESULTS: It was established that in 55 (88.7%) children high probability of infection existed in connection with past hospitalization and applied diagnostic and therapeutic procedures, such as: transfusion of blood and its preparations (24.19%), surgical procedures (22.58%), hospital treatment without invasive procedures and blood transfusions (19.35%). Familial exposure was a risk factor in 4.84% of cases, while in 6.45% of cases there were no burdens in the history. CONCLUSIONS: 1. In the evaluated group of children HCV infection was iatrogenic in character in majority of cases. 2. Hospitalization, even without invasive procedures, may be an important risk factor for HCV infection. 3. Familial exposure seems to be of secondary importance in transmission of HCV infection.

Influence of HBV or HCV associated chronic liver diseases on the course and outcome of purulent, bacterial meningoencephalitis.

BACKGROUND: Aim of the study was evaluation of HBV or HCV associated chronic liver diseases (HBV or HCV CHLD) influence on the course and outcome of purulent, bacterial meningoencephalitis (PBME), without symptoms of sepsis. MATERIAL AND METHODS: Between 1995-99 there were 8 patients with PBME, with chronic HBV (5 subjects) or HCV (3 subjects) infection, treated in our centre; mean age 43 years. Str. pneumoniae and N. meningitidis were etiologic factors of PBME in 25% and 12.5% of patients, respectively. In 62.5% of cases etiology of PBME remained unknown. In 2 patients HBV or HCV CHLD was diagnosed before PBME (1 case--chronic active hepatitis, 1 case--postinflammatory liver cirrhosis). During hospitalization due to PBME in 4 patients liver cirrhosis was diagnosed on the base of clinical picture and laboratory results, in 2 patients chronic hepatitis B or C was subject to further diagnostic procedures. RESULTS: In 7 subjects (87.5%) significant increase of AlAT and AspAT activity was recorded during acute phase of neuroinfection as compared to results preceding the hospitalization (to 300-400 U/l). Together with recovery from PBME decrease of aminotransferases activity was noted. In 1 fatal case high AlAT and AspAT activity was observed for the whole time of the disease. In 2 other patients with liver cirrhosis, classified into class A of Child-Turcott-Pugh classification at the beginning of PBME, after transient insignificant aminotransferases increase sudden decompensation of liver functions during recovery from PBME was observed. Both patients died due to haemorrhage from esophageal varices. In all patients with PBME and HBV or HCV CHLD inflammatory parameters of cerebrospinal fluid were increased for longer than average time. It was the reason of longer hospital stay. The influence of HBV or HCV CHLD on PBME outcome was not observed. CONCLUSIONS: 1. In patients with PBME concomitant HBV or HCV CHLD may exert negative influence on the course of neuroinfection and extend the period of hospitalization. 2. The increase of aminotransferases activity in these patients may suggest other hepatotropic virus superinfection and require further diagnostics. 3. In the case of HBV or HCV associated postinflammatory liver cirrhosis PBME may be connected with rapid liver disease progression and even the death of a patient.

[Cerebellitis in the course of varicella in a child: case report]. / Zapalenie mózdzku w przebiegu ospy wietrznej u dziecka--opis przypadku.

A case of cerebellitis as a complication of varicella in a 5-year old child was described. Special attention was paid to severe course of the disease and therapeutic problems. Actually available possibilities of active and passive prophylaxis of varicella-zoster virus infections were also discussed.

[The HLA-I and HLA-II expression evaluation in liver biopsy specimens of patients with chronic viral hepatitis]. / Ocena ekspresji antygenów HLA-I i II w bioptatach watroby chorych z przewleklym zapaleniem watroby o etiologii wirusowej.

The main an etiological agents of chronic hepatitis are viral infections. The viral infection course and outcome depend mostly on the immunological response. Infected hepatocytes are damaged by appropriately viral antigen-specific cytolytic T lymphocytes. Those sensitised T cells react only with those hepatocytes which express viral antigen and antigen HLA on membrane surface. The aim of this study was to evaluate the expression of selected histocompatibility antigens HLA in liver biopsy specimens of patients with chronic viral hepatitis. Seventeen patients with chronic persistent hepatitis (inflammatory activity 1-4 points according to Scheuer scale modified by Gabriel) and 27 patients with chronic active hepatitis (5-10 points) were studied. In these groups of patients the intensity of HLA-I (A, B, C), HLA-II (DR) expression in liver biopsy specimens, alanine aminotransferase activity, markers of HBV and HCV in serum were examined. The monoclonal mouse anti-human antibodies and streptavidin-biotin with alkaline phosphatase method for estimation of HLA-I, HLA-II was used. Results were statistically analysed using Mann-Whitney's U test and Spearman's rank correlation test. Generally, the expression of HLA-I and HLA-II on hepatocyte membrane was shown. Significant differences in expression of HLA-II among studied groups were observed, moreover the highest degree of HLA-II intensity in the group of patients with greater inflammation activity was significantly more frequently observed. The expression of HLA-I, HLA-II was regardless of the viral a etiology and serological markers of HBV replication. The degree of studied parameters expression was positively correlated with biochemical activity of inflammation.

[Diagnostic value of tumor necrosis factor-alpha (TNF-alpha) determination in cerebrospinal fluid (CSF) in the course of neural infections]. / Wartosc diagnostyczna oznaczania czynnika martwicy nowotworu--alpha (TNF-alpha) w plynie mózgowo-rdzeniowym w przebiegu neuroinfekcji.

In the central nervous system (CNS) infections a substantial role play inflammatory cytokines, especially TNF-alpha. They are implicated to initiate the local response leading to cerebral damage during meningitis. The purpose of this study was estimation of the diagnostic value of determining TNF-alpha concentrations in the CSF in the course of neuroinfections. Analyses were performed in 15 patients with purulent, bacterial meningitis (group A) and in 15 patients with lymphocytic meningitis (group B). CSF's concentrations of TNF-alpha were measured by the ELISA method (Genzyme Diagnostic, Cambridge, USA), on the day of admission and on the fourteenth day of treatment. In group A mean TNF-alpha concentration in CSF on admission was 285.73 pg/ml and in group B 4.07 pg/ml. On the fourteenth day of treatment mean TNF-alpha concentrations were 1.14 pg/ml and 0 pg/ml, respectively. The highest CSF TNF-alpha levels were observed in the most severely ill patients (group A). In several cases in this group there were positive correlations between TNF-alpha concentration and CSF white blood cell counts and protein concentration. Correlation of high levels of TNF-alpha with the severity of clinical course was observed in group B as well. Examination of CSF for TNF-alpha concentration could be useful in the differential diagnosis of CNS inflammations. TNF-alpha concentrations in CSF correlate with the severity of clinical course of meningitis and could have a prognostic value.

[Purulent meningoencephalitis treated in the Infectious Diseases Clinic of the Silesian Medical Academy in Bytom in 1994-1995: personal observations]. / Ropne zapalenia opon i mózgu leczone w i Klinice Chorób Zakaznych Slaskiej Akademii Medycznej w Bytomiu w latach 1994-1995: Obserwacje wlasne.

Among 267 patients with central nervous system infections, 43 patients (16.1%) suffered from purulent bacterial meningitis. An etiological agent was established in 15 cases (34.9%): Str. pneumoniae--9 cases, N. meningitidis--4 cases and Staph. aureus--2 cases. Most patients had severe course of the disease; lethality was 18.6%, the recovery with subsequent sequelae was noted in 11.6% cases, and 69.8% cases fully recovered. In two patients brain abscess and intracranial empyema, and persistent cerebral ischaemia were found, one of these patients died. Frequent use of antibiotics before hospitalization reduces the possibility of establishing the etiological agent. Bacterial infections of the central nervous system are still danger diseases producing high lethality and subsequent neurological sequelae.

[Purulent neuroinfections in the course of septicemia in the years 1988-1992: personal experience]. / Ropne neuroinfekcje w przebiegu posocznicy w latach 1988-1992: obserwacje wlasne.

Between 1988 and 1992 thirty patients with purulent infections of central nervous system in the course of bacterial septicaemia were treated in the Intensive Care Unit of the I Clinic of Infectious Diseases of Silesian School of Medicine in Bytom. These cases made about 32% of the total bacterial neuroinfections treated in the Clinic during that time. Imminent or existing acute respiratory insufficiency, increasing intracranial pressure, intensification of haemorrhagic diathesis and imminent septic shock were the indications to the hospitalization in the Intensive Care Unit. Neisseria meningitidis, Streptococcus pneumoniae and Escherichia coli were the most often found etiological factors in subsequently 53.33%, 33.33% and 3.34% of patients. In 10% of cases the etiological factors remained unknown. Intratracheal intubations and/or tracheotomies were carried out in over 60% of patients. About 40% of cases required assisted or controlled mechanical ventilation with the aid of ventilator (on the average 5 days). Mean time of hospitalization in the Intensive Care Unit closed in the period of 7 days. Mortality in the analyzed group was 23.33% (7 cases). Bacterial septicaemia with purulent infections of central nervous system often leads to the directly life threatening complications. Hospitalization in conditions of Intensive Care Unit affords possibilities for effective treatment and improvement of prognosis in patients suffering from these diseases.

[Posttraumatic meningoencephalitis in the material from the First Clinic of Infectious Diseases of Silesian Medical Academy in Bytom between 1986 and 1993]. / Pourazowe zapalenia opon i mózgu obserwowanie w I Klinice Chorób Zakaznych Slaskiej Akademii Medycznej w Bytomiu w latach 1986-1993.

Since 1986 to 1993 18 patients with bacterial, posttraumatic meningoencephalitis were hospitalized at the I Clinic of Infectious Diseases of Silesian Medical Academy in Bytom, and they made about 11.46% of the total purulent neuroinfections treated during that time. The group was composed of 16 men and one, 7-year-old girl, who was hospitalized twice. The course of the disease was very serious in 55.56% of cases and serious in the rest of patients. Permanent consequences subsequent to the disease like deafness, partial deafness and epilepsy were observed in 6 cases. Two patients died. After recovery gained by pharmacotherapy every patient was diagnosed with X-rays in order to find the spot of pathological connection between the cranium cavity and exterior environment, what afforded possibilities for neurosurgical or laryngological repair operation. The aim of the treatment was elimination of imminent recurrent infections of central nervous system. Accurate X-ray diagnostics and co-operation with surgical specializations enable us to improve prognosis and definitively restore patients to health after posttraumatic meningoencephalitis.

[Tetanus --observations in the I Clinic of Infectious Diseases, Silesian Medical Academy in Bytom in the years 1988-1992]. / Chorzy na tezec--obserwacje I kliniki Chorób Zakaznych Slaskiej Akademii Medycznej w Bytomiu w latach 1988-1992.

Fifteen patients with tetanus were treated in the I Clinic of Infectious Diseases in Bytom in the period 1988-1992; the clinical and epidemiologic analysis was carried out of them. Severe tetanus occurred in 66% of patients and 46% of them needed mechanical ventilation. The percentage of mortality was high (46.7%). It was found that the information about tetanus was inadequate among health service personnel (physicians) and the population. Attention is called to inadequate knowledge of tetanus prophylaxis in the first line of patient's contact with the health service, which increases the risk of tetanus development. For reducing the incidence of tetanus and for improvement the efficacy of treatment this disease the authors suggest the need of adequate tetanus prophylaxis (passive and/or active immunization) in high risk injured patients.