Multineuritis craneal y mielitis transversa como complicaciones de una meningitis neumocócica / Cranial multineuritis and transverse myelitis as complications of pneumococcal meningitis

Introducción: La meningitis neumocócica es una patología que asocia una elevada tasa de morbimortalidad. Caso clínico: Presentamos el caso clínico de un varón de 41 años que, tras una meningitis causada por Streptococcus pneumoniae, tuvo como complicaciones posteriores una mielitis transversa torácica que le ocasionó una plejía en las extremidades inferiores, abolición de todas las modalidades sensitivas y trastornos disautonómicos, así como una alteración de las astas anteriores a nivel cervical que produjo plejía en las extremidades superiores, pero con conservación de la sensibilidad. Esto plantea un diagnóstico diferencial entre la afectación denominada ‘poliomielitis like’ y una encefalomielorradiculitis diseminada aguda. La exploración y el estudio radiológico y neurofisiológico avalaron una recuperación clínica completa en las extremidades superiores, gracias, en parte, a una neurorrehabilitación precoz. Conclusiones: Las complicaciones medulares en el contexto de una infección del sistema nervioso central son muy infrecuentes. La afectación medular de astas anteriores se ha descrito únicamente de forma anecdótica, y no se han encontrado referencias bibliográficas que la asocien con S. pneumoniae.(AU)

Introduction: Pneumococcal meningitis is a condition associated with a high rate of morbidity and mortality. Case report: We report the clinical case of a 41-year-old man who, following meningitis caused by Streptococcus pneumoniae, developed subsequent complications such as thoracic transverse myelitis, which caused paralysis in the lower extremities, abolition of all sensory modalities and dysautonomic disorders, as well as an alteration of the anterior horn cells at the cervical level that produced paralysis in the upper extremities, but with preservation of sensibility. This implies the need for a differential diagnosis between what is known as ‘poliomyelitis-like’ disorder and acute disseminated encephalomyeloradiculitis. The examination and the radiological and neurophysiological study showed a full clinical recovery of the upper extremities, thanks in part to early neurorehabilitation. Conclusions: Complications of the spinal cord within the context of infection of the central nervous system are very rare. Involvement of the anterior horn cells of the spinal cord has only been described anecdotally, and no bibliographical references have been found that associate it with S. pneumoniae.(AU)

[Cranial multineuritis and transverse myelitis as complications of pneumococcal meningitis]. / Multineuritis craneal y mielitis transversa como complicaciones de una meningitis neumocócica.

INTRODUCTION: Pneumococcal meningitis is a condition associated with a high rate of morbidity and mortality. CASE REPORT: We report the clinical case of a 41-year-old man who, following meningitis caused by Streptococcus pneumoniae, developed subsequent complications such as thoracic transverse myelitis, which caused paralysis in the lower extremities, abolition of all sensory modalities and dysautonomic disorders, as well as an alteration of the anterior horn cells at the cervical level that produced paralysis in the upper extremities, but with preservation of sensibility. This implies the need for a differential diagnosis between what is known as 'poliomyelitis-like' disorder and acute disseminated encephalomyeloradiculitis. The examination and the radiological and neurophysiological study showed a full clinical recovery of the upper extremities, thanks in part to early neurorehabilitation. CONCLUSIONS: Complications of the spinal cord within the context of infection of the central nervous system are very rare. Involvement of the anterior horn cells of the spinal cord has only been described anecdotally, and no bibliographical references have been found that associate it with S. pneumoniae.

TITLE: Multineuritis craneal y mielitis transversa como complicaciones de una meningitis neumocócica.Introducción. La meningitis neumocócica es una patología que asocia una elevada tasa de morbimortalidad. Caso clínico. Presentamos el caso clínico de un varón de 41 años que, tras una meningitis causada por Streptococcus pneumoniae, tuvo como complicaciones posteriores una mielitis transversa torácica que le ocasionó una plejía en las extremidades inferiores, abolición de todas las modalidades sensitivas y trastornos disautonómicos, así como una alteración de las astas anteriores a nivel cervical que produjo plejía en las extremidades superiores, pero con conservación de la sensibilidad. Esto plantea un diagnóstico diferencial entre la afectación denominada 'poliomielitis like' y una encefalomielorradiculitis diseminada aguda. La exploración y el estudio radiológico y neurofisiológico avalaron una recuperación clínica completa en las extremidades superiores, gracias, en parte, a una neurorrehabilitación precoz. Conclusiones. Las complicaciones medulares en el contexto de una infección del sistema nervioso central son muy infrecuentes. La afectación medular de astas anteriores se ha descrito únicamente de forma anecdótica, y no se han encontrado referencias bibliográficas que la asocien con S. pneumoniae.

[Isolated hand palsy due to an ischaemic stroke]. / Paralisis aislada de la mano debido a un infarto isquemico.

TITLE: Paralisis aislada de la mano debido a un infarto isquemico.

[Relationship between homocysteinaemia and sympathetic skin response in Parkinson's disease]. / Relacion entre homocisteinemia y respuesta simpaticocutanea en la enfermedad de Parkinson.

INTRODUCTION: High levels of homocysteine linked to treatment with levodopa have been observed in patients with Parkinsons disease (PD). Our aim was to assess the influence of serum homocysteine levels and other PD-related on the sympathetic skin response. PATIENTS AND METHODS: An observational, cross-sectional study was conducted that consecutively included patients with PD. We unilaterally assessed the sympathetic skin response in the upper limbs. We measured the influence of PD severity (measured by the Hoehn and Yahr and the Schwab and England scales, and the Unified Parkinson Disease Rating Scale) and blood homocysteine, vitamin B12 and folic acid levels on the latency and amplitude of the sympathetic skin response. RESULTS: A total of 78 patients were enrolled, and all achieved a sympathetic skin response. In the bivariate analysis, latency was significantly correlated with age, age at PD onset and homocysteinaemia levels. The presence of hyper-homocysteinemia was associated with a longer latency. The amplitude was only correlated with the score on the Schwab and England scale. In the multivariate analysis, age was the only variable that showed a significant association with the latency duration and homocysteine levels. CONCLUSION: A direct association could not be established between the increase in homocysteinaemia levels and sympathetic skin response dysfunction in PD. The results of the multivariate analysis suggest that latency prolongation in elderly patients could be due to the fact that these patients have higher blood levels of homocysteinaemia.

TITLE: Relacion entre homocisteinemia y respuesta simpaticocutanea en la enfermedad de Parkinson.Introduccion. En la enfermedad de Parkinson (EP) se han observado niveles elevados de homocisteina en relacion con el tratamiento con levodopa. Nuestro objetivo ha sido valorar su influencia y la de otras variables relacionadas con la propia EP sobre la respuesta simpaticocutanea. Pacientes y metodos. Estudio observacional, transversal, en el que se incluyo de forma consecutiva a pacientes con EP. Se valoro la respuesta simpaticocutanea de forma unilateral en los miembros superiores, y se determino la influencia de la gravedad de la EP segun la Unified Parkinson Disease Rating Scale, y las escalas de Hoehn y Yahr y de Schwab y England, y de los niveles sanguineos de homocisteina, vitamina B12 y acido folico sobre la latencia y amplitud de la respuesta simpaticocutanea. Resultados. Se incluyo a 78 pacientes. La respuesta simpaticocutanea se obtuvo en todos ellos. En el analisis bivariante, la latencia se correlaciono significativamente con la edad, con la edad de inicio de la EP y con los niveles de homocisteina. La presencia de hiperhomocisteinemia se relaciono con una latencia mas prolongada. La amplitud solo se correlaciono con la puntuacion en la escala de Schwab y England. En el analisis multivariante, la edad fue la unica variable que demostro una asociacion significativa tanto con la duracion de la latencia como con los niveles de homocisteina. Conclusion. No pudo establecerse una asociacion directa entre el aumento de homocisteinemia y la disfuncion de la respuesta simpaticocutanea. Los resultados del analisis multivariante sugieren que la prolongacion de la latencia en los pacientes de una mayor edad podria deberse a que estos presentan unos mayores niveles sanguineos de homocisteina.

Invasive meningococcal disease in adolescents and young adults.

CONTEXT: Incidence of invasive meningococcal disease has increased recently in persons aged 15 through 24 years. OBJECTIVE: To characterize meningococcal infection in adolescents and young adults in Maryland during the 1990s. DESIGN AND SETTING: Population-based surveillance study for meningococcal disease from January 1, 1990, through December 31, 1999, in Maryland. PATIENTS: Maryland residents diagnosed as having invasive meningococcal disease. MAIN OUTCOME MEASURE: Invasive meningococcal infection. RESULTS: Of 295 total cases, 71 (24.1%) occurred among persons aged 15 through 24 years. Sixteen (22.5%) of these cases were fatal. The annual incidence rate increased from 0.9 to 2.1 cases per 100 000 among 15 through 24 year olds (P =.01). The proportion of all disease increased from 16.0% to 28.9% (P =.03). The incidence and proportion of cases subsequently decreased to 1.0 and 16.4% in 1998 through 1999, respectively. Infection in 15 through 24 year olds was more likely to be fatal than infection in those younger than age 15 years (22.5% vs 4.6%; P =.001). Infection in 15 through 24 year olds, compared with those aged 25 years or older, was more likely to be associated with male sex (66.2% vs 34.8%; P<.001) and serogroup C infection (46.9% vs 20.2%; P<.001), respectively. Infections were potentially preventable with the licensed meningococcal vaccine in 82.8% of 15 through 24 year olds, 68.1% of those younger than 15 years, and 76.8% of adults aged 25 years or older. CONCLUSIONS: Incidence of meningococcal infection in 15 through 24 year olds in Maryland increased and then declined during the 1990s. Infection in this age group was associated with an unusually high case-fatality ratio, and the vast majority of cases were potentially vaccine preventable.

Comparative clinical study of a new 17D thermostable yellow fever vaccine.

The immunogenicity and the safety of a new heat-stable 17D yellow fever vaccine have been assessed in a randomized comparative study by reference to a non-stabilized vaccine preparation. Seronegative adults were used and 115 and 143 were given the heat-stable and the non-stabilized vaccine, respectively. Fifty two days after the immunization, haemagglutination inhibiting antibodies were found in 77.6 and 73.9% of the vaccinees, neutralizing antibodies in 99.3 and 100% of them. The percentage of seroconversion and the geometric mean of antibody titres were not significantly different. No complaints or adverse reactions in association with the vaccines were recorded. This study demonstrates the high immunogenicity of this new stabilized vaccine whose stability has already been proven.

[A case of bouton d'orient]. / Une observation de Bouton d'Orient.

Oriental Sore is the dry cutaneous form of leishmaniasis, a parasitic infection common to man and to certain vertebrates and transmitted by insects: the phlebotomes. This benign tropical disease exists in South East France where it remains very rare, human contamination always being accidental. The lesions, single or multiple, affect the skin only. On the face, the differential diagnosis arises with other much commoner cutaneous lesions (impetigo, etc.). They consist, after 2 to 4 months of incubation, of a rounded erythematous papule, neither pruritic nor painful, which becomes secondarily excavated to produce a crusted ulcer. This lesion, typical at this stage, then persists for many months before an unsightly scar develops. Treatment is local: surgical excision offering the possibility of histological examination and hence a diagnosis. Plastic surgery may be used to correct scars in advanced forms.

Cryptosporidiosis in an immunosuppressed renal-transplant recipient with IgA deficiency.

Cryptosporidia are sporozoan parasites that infect epithelial cells of the gastrointestinal tract. Infection with cryptosporidia has been found most commonly in a variety of animal species and only rarely in man. The authors report a case of an immunosuppressed renal-transplant recipient with IgA deficiency who experienced diarrhea and fever and was found to have cryptosporidia in a jejunal biopsy specimen and in air-dried smears of the specimen. By electron microscopy, trophozoite, schizont, and macrogamete forms were identified, and these forms ahd morphologic features similar to those of cryptosporidia previously found in guinea pigs. Treatment of the cryptosporidial infection in this case was with trisulfapyrimidines. The efficacy of this treatment could not be evaluated because of complications.

[Histo-pathological features of African mycetomas (author's transl)]. / Aspects histo-pathologiques des mycétomes africains.

From a review of 94 original cases of mycetoma, a description of the most important histo-pathological features of these tumors is given. The microscopic diagnosis of mycetoma is easy and so is generally the identification of the responsible agent, either a bacteria or a fungus. In every case and specially in atypic ones a mycological study is necessary to ascertain the aetiological diagnosis.

[Hepato-cellular carcinoma associated with HBs antigen: a study of 25 cases from Vietnam (author's transl)]. / Association carcinome hépato-cellulaire du foie et antigéne HBs: étude de 25 cas au Vietnam.

Using orcein staining and indirect immunofluorescence on paraffin sections, the authors demonstrated HBs Ag in 64% of 25 hepatocellular carcinomas (including "bone metastasis") in Vietnam. The main findings in the literature suggesting a causal role for hepatitis B virus in primary liver cancer are discussed.