[Malignant external otitis caused by Pseudomonas aeruginosa. Report of 3 cases]. / Otite externa maligna por Pseudomonas aeruginosa. Relato de três casos.

The cases of three patients aged over sixty, diabetic for a long time and having clinical, otological, neurological and microbiological findings of malignant external otitis by Pseudomonas aeruginosa are registered. The first patient, a 62 years old woman, had important neurological alterations, such as proven P. aeruginosa meningitis and involvement of the 6th, 7th, 8th, 9th and 10th left cranial nerves. Although mortality and morbidity rates of cases with these characteristics are reported to be high, this patient survived. The second was a 64 years old male with the classical complaints of this condition consisting of persistent and intensive ear pain, serous purulent discharge and an emerging tumourous lesion in the left external ear canal. Good results were obtained with the surgical treatment administered along with an antimicrobial plan which remained incomplete because the patient has requested his discharge from the hospital. In less than one month, he was again hospitalized already presenting neurological manifestations (paralysis of the 6th cranial nerve) following a fatal course in a few days. The third was also a male patient, 70 years old, whose initial complaints occurred after a month a butterfly penetrated his right ear during his sleep. In spite of the presence of neurological troubles (facial paralysis and stupor) he survived with a prolonged antibiotic therapy. After a literature revision on this pathology, considerations are made concerning its pathogeny, clinical findings, diagnosis, therapy and prognosis.

Criptococose: meningoencefalite subaguda com hidrocefalia e hidrocefalia oculta, como expressoes clinicas - a proposito de tres casos. / Cryptococcosis: subacute meningoencephalitis with hydrocephalus and occult hydrocephalus as clinical expressions - apropos of 3 cases

Os autores registram tres casos de hidrocefalia secundaria a meningoencefalite subaguda de etiologia criptococica. Nao tendo o fungo sido encontrado no liquido cefalorraquidiano, foi iniciado, em todos os tres enfermos, esquema triplice contra tuberculose associado a corticoide. Em dois destes pacientes, derivacao ventriculo-peritoneal precedeu o reconhecimento da etiologia fungica. No terceiro doente, foi realizada drenagem ventricular de emergencia, substituida posteriomente por derivacao ventriculo-atrial. As meningites que obedecem a esta etiologia sao muito mais frequentes do que se julga e, quando a puncao lombar nao revela o fungo, e importante colher liquor da cisterna magna ou dos ventriculos para exame direto e cultura. Estes casos e outros indicam a necessidade da implantacao, em nosso meio, do diagnostico sorologico da criptococose.Por outro lado, trazem o ensinamento de que, em presenca de meningoencefalites subagudas e/ou de hidrocefalia, devem ser esgotados todos os recursos disponiveis para a procura desta etiologia, o que representa reais vantagens, pois o tratameto com anfotericina B e 5-fluorocitosina pode eximir o paciente da insercao de derivacao e de suas complicacoes, bem como evitar a dsseminacao da micose