ABSTRACT
The radiologist frequently is asked to contribute to the diagnosis of a patient with central nervous system infections, although radiologic findings usually are nonspecific. The radiologist can consider diagnostic possibilities with more accuracy if the clinician includes accurate demographic and epidemiologic information. This article organizes a broad range of central nervous system infections into demographic and epidemiologic perspective.
Subject(s)
Central Nervous System Infections/epidemiology , Central Nervous System Infections/diagnosis , Central Nervous System Infections/etiology , Cross-Sectional Studies , Diagnosis, Differential , Diagnostic Imaging , HumansSubject(s)
Fishes , Foodborne Diseases/etiology , Shellfish , Animals , Bacterial Toxins/poisoning , Botulism/etiology , Botulism/prevention & control , Botulism/therapy , Ciguatera Poisoning , Dinoflagellida/pathogenicity , Fishes/microbiology , Fishes/parasitology , Foodborne Diseases/prevention & control , Foodborne Diseases/therapy , Humans , Shellfish/microbiology , Shellfish/parasitologySubject(s)
Bites and Stings/epidemiology , Cats , Dogs , Adult , Animals , Bites and Stings/therapy , Child , Female , Humans , Male , Middle Aged , United StatesABSTRACT
Intravenously administered ampicillin (AMP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefamandole (CEF) were evaluated in 30 children with shigellosis: 11 children received AMP, 10 TMP-SMX, and 9 CEF for a maximum of five days. Discharge criteria included; afebrile greater than 12 hrs, less than 9 stools/day, absence of seizures, and adequate oral intake. AMP or TMP-SMX patients required significantly fewer median days to meet discharge criteria than those who received CEF. AMP and TMP-SMX patients had fewer median days with fever (one day each) compared with CEF (five days). On day five, 7 of 8 CEF, 3 of 10 AMP and 2 of 9 TMP-SMX treated patients remained culture positive. Inhibitory concentrations against all Shigella isolates from CEF patients all were less than or equal to 0.4 microgram CEF/ml. Intravenous TMP-SMX was equivalent to AMP in treatment of children with shigellosis, while CEF was ineffective despite in vitro activity. Clinical and bacteriologic responses were achieved with AMP and TMP-SMX in the majority of patients with less than 5 days of intravenous therapy.
Subject(s)
Ampicillin/therapeutic use , Cefamandole/therapeutic use , Cephalosporins/therapeutic use , Dysentery, Bacillary/drug therapy , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use , Child , Child, Preschool , Drug Combinations , Drug Evaluation , Female , Humans , Infant , Male , Random Allocation , Sulfamethoxazole/adverse effects , Trimethoprim/adverse effectsSubject(s)
Meningitis , Adult , Cephalosporins/therapeutic use , Cerebrospinal Fluid/cytology , Child , Child, Preschool , Chloramphenicol/therapeutic use , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases , Meningitis/diagnosis , Meningitis/epidemiology , Meningitis/physiopathology , Meningitis/therapy , Meningitis, Haemophilus , Meningitis, Meningococcal , Meningitis, Pneumococcal , Penicillins/therapeutic use , Prognosis , United States , Vancomycin/therapeutic useABSTRACT
A 38-day-old infant had fever, jaundice, hepatosplenomegaly, and a hemolytic anemia. A peripheral blood smear demonstrated intraerythrocytic malarial parasites identified as Plasmodium vivax. Maternal and infant sera contained antibodies to this species. A directed history revealed the mother had suffered several febrile illnesses in Mexico during her pregnancy. Malaria had not been diagnosed nor was it considered at the time of her delivery at this hospital. Review of this and six other cases of congenital malaria reported in this country since 1950 indicates clinical manifestations seldom appear before 3 weeks of age. Although these signs are more frequently associated with other transplacental infections, their occurrence in an infant whose mother is from or who has traveled in an endemic area should prompt consideration of the diagnosis of congenital malaria.
Subject(s)
Anemia, Hemolytic/etiology , Malaria/congenital , Splenomegaly/etiology , Adult , Female , Humans , Infant , Infant, Newborn , Malaria/complications , Male , Mexico , Plasmodium vivax , Pregnancy , Pregnancy Complications, Infectious , United StatesABSTRACT
A randomized therapeutic trial of carbenicillin (CB) or ampicillin (AMP) in purulent meningitis was performed in 86 pediatric and adult patients (41 Haemophilus influenzae, 22 Streptococcus pneumoniae, 13 Neisseria meningitidis, and 10 of unknown etiology). All isolates, incuding H. influenzae, were susceptible to CB and AMP. Median cerebrospinal fluid (CSF) antibiotic concentrations were 0.85 and 1.60 mug/ml for CB and AMP, respectively, during administration of daily doses of 400 mg/kg and 0.65 and 0.45 mug/ml, respectively, on daily doses of 200 mg/kg. Higher CSF concentrations, up to a median concentration of 4.5 mug/ml, were observed in patients with CSF protein concentrations >/=75 mg/100 ml. Clinical responses were equivalent on either antibiotic regimen. Among AMP patients (45), 8 had significant residua and 3 died; among CB patients (41), 5 had residua and none died. However, 38% of H. influenzae patients treated with CB had positive CSF cultures on day 1 follow-up lumbar punctures, compared with only 5.8% of AMP patients with H. influenzae. The significance of a delay of CSF sterilization among CB-treated patients is unknown, since there was no correlation between persistence of hemophilus organisms and the frequency of adverse outcome. AMP and CB are equivalent for the treatment of bacterial meningitis due to susceptible organisms.
