1/9. Successful treatment of meningitis caused by highly-penicillin-resistant streptococcus mitis in a leukemic child.In recent years, viridans streptococci have been reported with increasing frequency to cause infections in neutropenic cancer patients. streptococcus mitis, one of the species included among viridans streptococci, is the most resistant to beta-lactam antibiotics in this group. Bacterial meningitis presenting without pleocytosis in the cerebrospinal fluid (CSF) is rare, and this situation could be confusing to physicians. It is also an uncommon infectious complication in leukemic patients with neutropenia. In patients with leukopenia caused by myelosuppression after chemotherapy, bacterial meningitis must be considered a possibility when a patient develops meningeal signs, even if no pleocytosis is found in the CSF. We report on a 6-year-old boy with leukemia and neutropenia who developed sepsis and meningitis caused by S. mitis with high-level resistance to penicillin and cephalosporins (MIC of both, >2 mg/l); he was a long-term survivor receiving chronic trimethoprim-sulfamethoxazole prophylaxis. The patient was successfully treated with a combination of vancomycin, ceftriaxone, and granulocyte-colony-stimulating factor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. A cluster of anthrax cases including meningitis.We report a common-source outbreak of anthrax. The source of infection was the carcass of a cow. Three patients developed anthrax, which affects meninx, skin and larynx. The patient with meningitis died. In all, 20 people who contacted or ate the cooked meat of the dead cow were given prophylactic tetracycline and remained well. This small outbreak calls for the increased awareness of physicians to this clinical entity in locations in which anthrax is endemic and for health education.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Acute symptomatic hydrocephalus in listeria monocytogenes meningitis.listeria monocytogenes meningitis appears to have increased in incidence. Although most reported cases of listeriosis involve the central nervous system, brain computed tomography is usually normal. hydrocephalus is a common complication of tuberculous meningitis, which has a high prevalence in taiwan. However, patients with L. monocytogenes meningitis rarely develop the complication of symptomatic hydrocephalus. We report a patient with L. monocytogenes meningitis who presented with persistent alteration of consciousness after appropriate antimicrobial therapy. Follow-up brain computed tomography revealed acute hydrocephalus. An Ommaya reservoir was implanted, and daily drainage of the cerebrospinal fluid was performed. The patient improved gradually and his mental status recovered completely 4 days later. This case should remind physicians to be aware of the possible occurrence of hydrocephalus in L. monocytogenes meningitis and that prompt cerebrospinal fluid drainage may achieve a good outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Malignant cerebral edema and intracranial hypertension.Cerebral edema and intracranial hypertension occur frequently in neurologic patients. Proper understanding of the pathophysiology of each entity allows prompt recognition and rational therapeutic goals, allowing for better neurologic outcome in many disease states. The recognition of cerebral edema as a distinct entity allows the clinician to treat focal pressure gradients in the brain separately from more diffuse intracranial pressure elevations, appreciating the benefits and pitfalls of directed therapies for each process. The treatment of many of the disorders that cause cerebral edema and intracranial hypertension is heuristic, challenging the managing physician's thorough understanding of cerebral hemodynamics and his or her ability to encounter the human aspects of determining appropriate levels of care for individual patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Neurologic evaluation of the patient with acute bacterial meningitis.Major advances in our understanding of the pathophysiology of bacterial meningitis have been made in the past decade. It is likely that interventional strategies that mediate the effects of vasoactive metabolites and neuronal and glial toxins will improve the outcome of patients with meningitis as well as other neurologic disorders. Of critical importance, as demonstrated in the case history, is the realization that many of the serious complications of meningitis occur very early in the course of the disease. If new treatment strategies are to be effective, they should be started as soon as possible. Emerging technologies such as proton magnetic resonance spectroscopy may be of benefit in helping physicians decide which patients require treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Bacterial meningitis with normal cerebrospinal fluid findings. Report of a case and review of the literature.Bacterial meningitis presenting with normal initial CSF findings is rare and could be confusing to the physicians. Such an entity was observed in this first case report from lebanon on an 8-month-old female febrile infant whose initial CSF studies were normal despite the culture yielding streptococcus pneumoniae. Thus, this case emphasizes the need that physicians should start antimicrobial therapy, pending culture results, whenever bacterial meningitis is clinically suspected, even if initial CSF investigation of cellular, protein, sugar and gram-strain results do not reveal abnormal findings. In addition, repeat lumbar puncture should be considered in all febrile patients having clinical features suggestive of this diagnosis.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/9. staphylococcus aureus meningitis associated with pyogenic infection of the sacroiliac joint.Although we have reported the first case of staphylococcus aureus meningitis due to pyogenic arthritis of the sacroiliac joint, this finding is actually not surprising, given the strong association between this form of meningitis and underlying bone, joint, and soft tissue infections. The physician faced with a case of meningitis due to S aureus in a patient without a history of trauma or neurosurgical manipulation must do a prompt and thorough search for underlying infectious conditions. In the case of sacroiliitis in particular, a high index of suspicion needs to be maintained, given the difficulties and delays in diagnosis associated with this infection. Radionuclide scanning with 99mTc or 67Ga is usually helpful in the early confirmation of this condition, the presence of which may be suspected on the basis of thorough physical examination.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Can seizures be the sole manifestation of meningitis in febrile children?OBJECTIVE. It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis. DESIGN. Retrospective case series. SETTING AND patients. 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period. MAIN OUTCOME MEASURES. signs and symptoms of meningitis in patients having associated seizures. RESULTS. meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found. CONCLUSION. In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Bacterial meningitis and lumbar epidural hematoma due to lumbar acupunctures: a case report.A 48-year-old female expressed signs of meningeal irritation after having received several lumbar acupunctures within one week for back pain. Bacterial meningitis was diagnosed from cerebrospinal fluid examinations. Magnetic resonance image (MRI) of spine at admission demonstrated a fusiform lesion with characters of subacute hematoma in the epidural space of the first and second lumbar level. She received antibiotics treatment only and recovered from her central nervous system infection completely. The epidural lesion disappeared spontaneously in the MRI follow up three weeks later. We report the diagnosis and follow-up of epidural hematoma of the lumbar spine by MRI which aided the medical physician to treat meningitis attentively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |