[Purulent meningitis in an adult patient caused by multi-drug resistant Streptococcus pneumoniae 19A]. / Polirezisztens Streptococcus pneumoniae 19 A okozta megningitis purulenta felnoöttkorban.

UNLABELLED: This is the first report in Hungary about meningitis caused by multiply-resistant Streptococcus pneumoniae in a 54 year old woman. The Streptococcus pneumoniae serotype 19A was highly resistant to penicillin, ampicillin, chloramphenicol, cefuroxime and intermediate resistant to ceftriaxone. The antibiotic treatment was started with penicillin and ampicillin. The antibiotic treatment was changed to vancomycin + ceftriaxone, vancomycin + rifampicin and vancomycin + imipenem on the 2nd, 4th and 11th hospital days, respectively. She died on the 29th day with symptoms of sepsis. Necropsy and microscopic examination of the brain revealed localised inspissed layer of purulent exsudat over the convexities. Under this area the small wessels and capillaries were thrombotic and were surrounded by severe degeneration and necrosis in the white matter. RECOMMENDATIONS: Streptococcus pneumoniae has to be considered penicillin resistant until the organism is proved to be susceptible to penicillin. The authors advise the administration of dexamethasone, based on their own favourable 7 years experience.

A randomised comparison of meropenem with cefotaxime or ceftriaxone for the treatment of bacterial meningitis in adults. Meropenem Meningitis Study Group.

Third-generation cephalosporins are presently the agents of choice for the empirical antimicrobial therapy of bacterial meningitis. However, a number of factors associated with these agents, namely the development of resistance by pneumococci, limited activity against some Enterobacteriaceae and Pseudomonas spp., and the possible adverse effects of their bacteriolytic mode of action, indicate that newer classes of antimicrobial agents be evaluated for the treatment of bacterial meningitis. Meropenem is a carbapenem antibiotic which is highly active against the major bacterial pathogens causing meningitis, and penetrates well into the cerebrospinal fluid. Two prospective randomised studies in 56 adult bacterial meningitis patients have compared meropenem 40 mg/kg 8-hourly, up to a maximum of 6 g/day (n = 28) with cephalosporin treatment, i.e. cefotaxime (n = 17) or ceftriaxone (n = 11). Patients were assessed by neurological examination, Glasgow Coma Score and Herson-Todd score. Clinical cure was observed in all 23 evaluable patients treated with meropenem (100%) and with 17 of the 22 evaluable cephalosporin-treated patients (77%). All pre-treatment isolates were eradicated except one isolate of Staphylococcus aureus in a cefotaxime-treated patient. Neurological sequelae were noted in three meropenem and four cephalosporin-treated patients. No patients in either treatment group experienced seizures after the start of therapy. This was despite the fact that a patient in each group had experienced seizures before therapy, several had underlying CNS disorders, and that doses of 6 g/day of meropenem were given. Hearing impairment was recorded in 11 meropenem and nine cephalosporin treated patients. Three patients in the meropenem group and one in the cephalosporin group died during treatment for reasons unrelated to study therapy. Overall, the results of this study indicate that meropenem is an effective and well-tolerated antibiotic for the treatment of bacterial meningitis in adults.

[Varicella pneumonia in adults]. / Varicella pneumonia felnöttkorban.

The authors treated 93 adult patients (83 male, 10 female) with varicella from 1st June 1987 to 30th April 1991. 13 patients had varicella pneumonia, two patients died. Special attention has been focused upon the diagnostic and prognostic problems, including bacterial superinfection. Authors stress the importance of the early diagnosis and treatment and discuss in detail the recent therapeutical and prophylactic opportunities.

[Purulent meningitis, caused by Corynebacterium xerosis, after spinal anesthesia]. / Corynebacterium xerosis okozta meningitis purulenta spinális anaesthesia után.

A previously healthy 25 year old sportsman is reported who developed Corynebacterium xerosis meningitis with coma and seizures after spinal anaesthesia. The adequate therapy (dexamethason, penicillin, ampicillin, mannitol, intensive care, hyperventillation) resulted in a complete recovery. To the authors' knowledge this is the first case of Corynebacterium xerosis meningitis and the first bacterial meningitis reported after spinal anaesthesia in Hungary.

Acute monosymptomatic aseptic meningitis caused by Toxoplasma gondii.

Acute monosymptomatic aseptic meningitis was observed in a 4 year old male patient. Toxoplasma gondii tachyzoites were detected in Giemsa-stained smears prepared from the CSF. Inoculation of mice gave the same result. The patient was cured after the application of pyrimethamine and sulpha drugs. On basis of the smears, the serological results and data in the literature, a direct infection through the nasal cavity has been assumed.