1/87. Acute abdomen as an atypical presentation of meningococcal septicaemia.The clinical manifestations and course of meningococcal disease have been well described, but atypical presentations may, if unrecognized, lead to a delay in treatment. We describe here an unusual case of this disease in a 21-y-old woman who presented with an acute rigid abdomen, clinical and laboratory features of sepsis, shock and early DIC with no indication of meningococcal infection. She developed a rapidly spreading purpuric rash, conjunctival haemorrhages, hypotension and tachycardia and a low urine output. Laboratory investigations showed a low platelet count, low haemoglobin and normal WBC. A presumptive diagnosis of meningococcal septicaemia was made and recovery followed treatment with cefotaxime, fluids and inotropes. A fully sensitive neisseria meningitis Group C, type 2a, subtype NT was isolated from blood cultures, but not from CSF obtained after antibiotic treatment.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/87. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.- - - - - - - - - - ranking = 7keywords = meningitis (Clic here for more details about this article) |
3/87. Congenital asplenia detected in a 60 year old patient with septicemia.A 60 year-old female who had never been seriously ill, was brought to the emergency ward after she had been found somnolent at home. She developed renal failure, meningitis, respiratory distress and disseminated intravascular coagulation. Overwhelming septicemia was evident, and streptococcus pneumoniae was isolated from blood and cerebrospinal fluid. Surprisingly, peripheral blood smears showed numerous Howell-Jolly-bodies, indicating severe impairment of splenic function. On abdominal ultrasound, CT-scan, and scintigraphy no spleen could be detected. There was no history of abdominal surgery. Apparently, congenital asplenia, which was not noticed until the age of 60, was responsible for the patient's life-threatening septicemia. We suggest that, in cases of severe septicemia, the examination of a blood smear is useful to detect functional (or congenital) asplenia.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
4/87. Disseminated infection due to nocardia transvalensis coincident with cryptococcus neoformans variety gattii meningitis.A case of meningitis due to cryptococcus neoformans var. gattii coincident with disseminated nocardia transvalensis infection is reported. nocardia infection initially progressed despite high-dose antimicrobial therapy. Although a specific immunologic defect could not be defined, in vitro lymphocyte proliferation in response to stimulation with the nocardia isolate was reduced. It is proposed that coinfection with cryptococcus neoformans may have contributed to the observed impairment of lymphocyte function, leading to disseminated nocardia disease and a suboptimal treatment response.- - - - - - - - - - ranking = 5keywords = meningitis (Clic here for more details about this article) |
5/87. staphylococcus aureus endocarditis presenting as meningitis and mimicking meningococcal sepsis.A case of staphylococcus aureus meningitis (SAM) secondary to endocarditis is presented. The presence of a petechial rash affecting the lower limbs led to an initial presumptive diagnosis of meningococcal meningitis. There were no stigmata of endocarditis at presentation, though these subsequently developed. Underlying endocarditis should be diligently sought in any patient presenting with spontaneous SAM, even if typical stigmata are initially absent. In view of the association with skin lesions and neurological complications, S. aureus endocarditis may mimic the classical presentation of meningococcal sepsis.- - - - - - - - - - ranking = 6keywords = meningitis (Clic here for more details about this article) |
6/87. Fulminant septicaemic syndrome of bacillus cereus: three case reports.Three patients with acute leukaemia, who were severely neutropenic and iatrogenically immunosuppressed post-chemotherapy, developed rapidly fatal septicaemic shock and coma caused by bacillus cereus (B. cereus). The illness was marked by two phases: a mild febrile illness lasting 6-14 h and accompanied by subtle symptoms of autonomic sympathetic nervous system overactivity, and a second short fulminant one, marked by high fever of 40-41 degrees C accompanied by major central nervous system disturbances, and ending with deep coma and brain stem dysfunction. One patient developed the sepsis in spite of 4 days of coverage with amikacin. In the other two patients, amikacin was commenced at the earliest phase of the infection, but failed to influence the outcome. This form of B. cereus sepsis in neutropenic patients seems to be caused by strains capable of causing bacteraemia and meningitis and has the ability to produce a substance that causes leptomeningeal and neuronal necrosis. Lack of early clinical and laboratory markers inevitably leads to death. Use of antibiotics effective against B. cereus and capable of achieving high concentrations in the cerebrospinal fluid. and identification and neutralization of the necrotizing substance may hopefully help to reverse this fatal illness.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
7/87. bacteremia, meningitis, and brain abscesses in a hospitalized infant: complications of pseudomonas aeruginosa conjunctivitis.This report describes a preterm infant hospitalized in a neonatal intensive care unit who developed pseudomonas aeruginosa conjunctivitis associated with bacteremia, meningitis, and multiple brain abscesses. P. aeruginosa conjunctivitis can rapidly progress to an invasive eye infection, such as corneal ulceration or endophthalmitis, leading to poor vision or blindness. Progression of this infection may lead to systemic disease. However, as illustrated in this report, P. aeruginosa conjunctivitis may be associated with the development of systemic complications such as bacteremia and meningitis in the absence of invasive eye disease. P. aeruginosa is a relatively common cause of conjunctivitis in hospitalized preterm and low birth weight infants. Given the severity of the ocular and systemic complications of Pseudomonas conjunctivitis, clinicians are reminded that prompt detection and treatment of neonatal conjunctivitis is critical.- - - - - - - - - - ranking = 6keywords = meningitis (Clic here for more details about this article) |
8/87. citrobacter diversus urosepsis and cerebral abscess in a child with antenatal hydronephrosis.One percent of all pregnancies are found to have an antenatal abnormality; of these, 20% involve the genitourinary system. Today, controversy still exists regarding the postnatal management of some antenatal abnormalities detected by ultrasound. We present a case in which antenatal hydronephrosis initially detected by ultrasound appeared to resolve in utero. Postnatally, the child developed citrobacter diversus urosepsis, meningitis, and cerebral abscess. Voiding cystourethrogram obtained after resolution of sepsis revealed grade IV reflux. This case underscores the importance of a full postnatal evaluation for all children with antenatal hydronephrosis and alerts clinicians to a virulent pathogen not commonly associated with urinary tract infection.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
9/87. citrobacter sepsis and severe newborn respiratory failure supported with extracorporeal membrane oxygenation.An infant with fulminant citrobacter sepsis and respiratory failure is presented. The severity of respiratory failure and the need for systemic heparinization on extracorporeal membrane oxygenation delayed the opportunity of initial lumbar puncture to rule out meningitis. The infant was successfully treated with extracorporeal membrane oxygenation and long-term antibiotics. Repeated cranial computed tomography scans remained negative for intracerebral abscesses, and the infant is within normal limits for growth, neurologic status, and developmental status.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
10/87. Management and prevention of meningococcal disease.While many other illnesses affecting children have been contained or even eliminated, meningococcal disease has become a leading infectious cause of death. The major management challenge may be increased intracranial pressure or toxic shock, depending on whether meningitis or septicemia predominates. A new protein-conjugated group C vaccine is expected to reduce deaths by as much as 40%.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
| | Next -> |