Case Reports. Chronic and acute Aspergillus meningitis.

Cerebral aspergillosis usually occurs in severely immunocompromized hosts, is difficult to diagnose, and has a poor prognosis. After 14 months of chronic meningitis, ventriculitis, choroid plexitis, and lumbar arachnoiditis, which was complicated by acute hydrocephalus, Aspergillus, suspected to be from the candidus group, was isolated from the cerebrospinal fluid (CSF) of a previously healthy man. Thereafter Aspergillus antigen was found in stored plasma and CSF samples. He was treated with voriconazole and itraconazole. In a haemodialysis patient affected by an acute meningococcal meningitis, following a 3-day symptom-free interval, symptoms and signs of acute meningitis had reappeared and were unresponsive to a broad antimicrobial coverage. However, they resolved within 5 days after liposomal amphotericin B treatment had been started. From his CSF Aspergillus-DNA was identified and Aspergillus fumigatus isolated by culture. These two different clinical cases show that Aspergillus-DNA and antigen detection tests represent an advance in the diagnosis and liposomal amphotericin B, voriconazole, and itraconazole are an advance in the treatment of Aspergillus meningitis.

Temporal arteritis associated with Chlamydia pneumoniae DNA detected in an artery specimen.

Temporal arteritis is a clinical manifestation of giant cell arteritis. The etiology of this disease is still unknown. Sudden onset and wide variations of incidence are reported in different parts of the world. Acute onset is often associated with flu-like symptoms, indicating that infectious factors probably act as precipitating agents. We describe a 72-year-old man referred to our department in January 1999 for unremitting fever and temporal arteritis associated with Chlamydia pneumoniae infection.