11/318. CSF interleukin-6 in neonatal Citrobacter ventriculitis after meningitis.An infant with neonatal severe citrobacter koseri (formerly Citrobacter diversus) meningoencephalitis developed necrosis with multicystic regression of both hemispheres. The ventriculitis persisted over months in spite of antibiotic therapy.The treatment succeeded with cefotaxime in a high dose (300 mg/kg/day) without surgical intervention.The infant had been previously treated with cefotaxime (200 mg/kg/day) over 5 weeks. High levels of CSF interleukin-6 (IL-6) permitted to attribute persisting CSF pleocytosis in spite of sterile CSF cultures to chronic infection and not to reminiscence of brain necrosis. This report reveals two main points. On the one hand, the importance of therapy monitoring with IL-6 in CSF for the consequent treatment of Citrobacter meningitis and on the other hand, high-dose cefotaxime (300 mg/kg/day) treatment of Citrobacter ventriculitis, which succeeded without surgical intervention.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/318. Raccoon roundworm (Baylisascaris procyonis) encephalitis: case report and field investigation.Baylisascaris procyonis is a common and widespread parasite of raccoons in the united states and canada. With large raccoon populations occurring in many areas, the potential risk of human infection with B procyonis is high. We report a case of severe raccoon roundworm (B procyonis) encephalitis in a young child to illustrate the unique clinical, diagnostic, and treatment aspects, as well as public health concerns of B procyonis infection. Acute and convalescent serum and cerebrospinal fluid samples from the patient were tested for antibodies against B procyonis to assist in documenting infection. An extensive field survey of the patient's residence and the surrounding community was performed to investigate raccoon abundance and to determine the extent of raccoon fecal contamination and B procyonis eggs in the environment. The patient evidenced serologic conversion, and the field investigation demonstrated a raccoon population far in excess of anything previously reported. There was abundant evidence of B procyonis eggs associated with numerous sites of raccoon defecation around the patient's residence and elsewhere in the community. Because B procyonis can produce such severe central nervous system disease in young children, it is important that pediatricians are familiar with this infection. The public should be made aware of the hazards associated with raccoons and B procyonis to hopefully prevent future cases of B procyonis infection.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
13/318. Chromosomal rearrangements affecting biofilm production and antibiotic resistance in a staphylococcus epidermidis strain causing shunt-associated ventriculitis.During two clinical courses of shunt-associated meningitis in a 3-month-old child, five multiresistant S. epidermidis isolates were obtained and analyzed with regard to biofilm production and antibiotic susceptibility. Three S. epidermidis strains, which were initially isolated from the cerebrospinal fluid, produced biofilms on polystyrene tissue culture plates. Following antibiotic treatment and subsequent exchange of the shunt system, sterilization of the CSF was achieved. However, after three weeks a relapse of the infection occurred. The two S. epidermidis isolates obtained now were biofilm negative, but showed an identical resistance pattern as those from the previous infection, except that resistance to rifampicin and increased mininal inhibitory concentrations of aminoglycoside antibiotics had emerged. dna fingerprinting by PFGE indicated the clonal origin of all isolates. However, some DNA rearrangements and differences in the IS256-specific hybridization patterns could be identified in the isolates from the second infection period that led to altered biofilm formation and increased expression of aminoglycoside resistance traits. The data evidence that variation of biofilm expression occurs in vivo during an infection and highlight the extraordinary genome flexibility of pathogenic S. epidermidis.- - - - - - - - - - ranking = 4keywords = infection (Clic here for more details about this article) |
14/318. pharmacokinetics of intraventricularly administered teicoplanin in Staphylococci ventriculitis.Following craniotomy for a medulloblastoma in the posterior cranial fossa, a 6-year old girl developed a ventriculitis with coagulase negative staphylococci associated with the use of a ventriculostomy. Treatment with intravenous (i.v.) and intraventricular (ivt) vancomycin resulted in negative cultures of the cerebrospinal fluid, but had to be stopped because of a severe allergic skin reaction. teicoplanin was administered i.v. (240 mg once daily) and ivt (10 mg once daily), resulting in high teicoplanin CSF levels that were used to model the pharmacokinetics of ivt teicoplanin in this patient. No signs of recurrent infection or adverse events occurred. It is concluded that a pharmacokinetic model can be derived from this case that can be used as prior to guide teicoplanin intraventricular therapy in other patients.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
15/318. Ventriculitis due to cryptococcus uniguttulatus.Infections due to non-neoformans cryptococci are rare. We report the first case of a human infection caused by cryptococcus uniguttulatus. Ventriculitis caused by this organism developed in a 65-year-old woman who had had repair of an internal carotid aneurysm. in vitro sensitivity testing showed the cryptococcus species sensitive to amphotericin b and itraconazole. Treatment with amphotericin led to resolution of the infection.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
16/318. q fever encephalitis with cytokine profiles in serum and cerebrospinal fluid.A 7-year-old boy with acute encephalitis was proved to have coxiella burnetii infection. cerebrospinal fluid but not serum had elevated values of interleukins 1-beta and 6, but not of tumor necrosis factor.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
17/318. Brainstem and striatal encephalitis complicating mycoplasma pneumoniae pneumonia: possible benefit of intravenous immunoglobulin.Encephalitides of the brainstem and the striatum associated with mycoplasma pneumoniae infection are believed to be mediated by an autoimmune process triggered by the organism, a toxin or direct invasion by the organism itself. Inability to identify M. pneumoniae from cerebrospinal fluid by culture or polymerase chain reaction suggested a possible immunologic process. A trial of intravenous immunoglobulin in a critically ill patient with encephalitis that developed in parallel to M. pneumoniae pneumonia was associated with neurologic improvement within 48 h of treatment.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
18/318. Acute encephalopathy as a primary manifestation of haemophagocytic lymphohistiocytosis.Haemophagocytic lymphohistiocytosis (HLH) is characterized anatomically by an infiltration of multiple tissues with lymphocytes and haemophagocytic histiocytes. First symptoms are usually hepatosplenomegaly, pancytopenia, and intractable fever. Up to 73% of those with HLH develop CNS involvement during the disease course. The peculiarity of the two patients presented here, a 20-month-old Italian female and a 4-year-old Moroccan female, is that the initial presenting neurological symptoms mimicked an encephalitis, anticipating the typical systemic symptoms by 1 and 4 months. They developed progressive encephalopathy accompanied by status epilepticus, one child developed a secondary hydrocephalus. In both children it was not possible to detect an underlying infection or malignant disease and there were no other cases in the family that suggested a familial form of HLH. Diagnosis and initiation of treatment was delayed because of the initial encephalopathic clinical picture and the late onset of the typical systemic features. As early diagnosis allows better therapeutical approaches, haemophagocytic lymphohistiocytosis should be considered in children with persistent or progressive findings of encephalopathy, especially in the absence of identification of a plausible pathogen.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
19/318. Toxoplasmic encephalitis and primary lymphoma of the brain--the shift in epidemiology: a case series and review of the literature.With the advent of HAART, there has been a decline in the incidence of AIDS-defining illnesses. Despite this decline, we increasingly see patients who present with AIDS-defining illnesses similar to those seen during the early days of the hiv epidemic because patients are having difficulty in tolerating or adhering to their HAART regimens. In general, patients today are different: some are receiving prophylaxis to prevent hiv-related infections and many have experienced a more prolonged duration of immunosuppression resulting from intermittent use of HAART. We present 4 patients with neurologic symptoms and focal brain lesions and review and compare the diagnosis and treatment of toxoplasmic encephalitis with that of primary CNS lymphoma.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
20/318. Eosinophil-associated inflammation and elaboration of eosinophil-derived proteins in 2 children with raccoon roundworm (Baylisascaris procyonis) encephalitis.OBJECTIVE: Eosinophil-associated proteins, especially eosinophil-derived neurotoxin, may be important contributors to the neurologic pathology and symptoms caused by Baylisascaris procyonis infection. methods: Two cases of severe B procyonis encephalitis with evidence of marked eosinophil degranulation in the central nervous system are presented. Serial cerebrospinal fluid (CSF) specimens were collected from each patient during the course of their illness. antibodies against B procyonis were measured in the patients' serum and CSF. Levels of the eosinophilopoietin interleukin-5 (IL-5) and 2 important eosinophil proteins, eosinophil-derived neurotoxin and major basic protein, were assayed in the CSF. RESULTS: Both patients had rapidly progressive central nervous system disease with evidence of eosinophilic meningoencephalitis. Both tested positive for antibodies to B procyonis in serum and CSF and had progressively worsening deep white matter changes on magnetic resonance images of the brain. CSF levels of IL-5, eosinophil-derived neurotoxin, and major basic protein were markedly elevated over controls. CONCLUSIONS: This is the first report of the measurement of IL-5, eosinophil-derived neurotoxin, and major basic protein in human CSF. In addition to traumatic damage and necrosis caused by migrating larvae, eosinophil-derived neurotoxin from associated eosinophilic inflammation may be an important contributory factor in the pathogenesis of B procyonis encephalitis. parasite, eosinophil-derived-neurotoxin, major basic protein, eosinophilia, hypereosinophilia, interleukin-5, encephalitis, child.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
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