1/6. Clinically inapparent meningitis complicating periorbital cellulitis.Two young children with periorbital (preseptal) cellulitis were found to have meningitis despite having no signs of meningeal irritation and normal cerebrospinal fluid (CSF) cell counts and chemistries. These cases are reported to remind physicians caring for acutely ill children that periorbital cellulitis can have life-threatening complications and that meningitis can occur in the absence of significant clinical signs and in the presence of an initially normal CSF.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Recurrent meningitis: a case report.Recurrent meningitis is an uncommon clinical problem. It is most likely to result from head trauma. streptococcus pneumoniae is the most common infecting pathogen. Computed tomographic techniques are required to identify persistent bony defects in the skull that might predispose to this disorder. Because emergency physicians regularly care for victims of head trauma and meningitis, knowledge of this entity can be useful.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Pneumococcal vaccine and hiv infection: report of a vaccine failure and reappraisal of its value in clinical practice.A clinical failure of pneumococcal vaccine is reported. A 22 year old African woman was given 23-valent pneumococcal vaccine at her initial presentation with hiv infection. She was asymptomatic and had a CD4 lymphocyte count above 500 cells/mm3. Eighteen months later she died of meningitis and septicaemia due to streptococcus pneumoniae type 9 (an antigen included in the 23-valent vaccine). Pneumococcal antibody levels performed on stored blood demonstrated no serological response to the vaccine. This is the first reported case of clinical failure of pneumococcal vaccine in an hiv infected patient who received vaccine whilst at the asymptomatic stage of hiv infection and with relatively intact immune function. The literature pertaining to pneumococcal vaccination in the context of hiv infection was reviewed. Pneumococcal vaccination is recommended for hiv positive patients in the UK by the Departments of health. It is likely that many physicians are not aware of these recommendations or are concerned about the poor efficacy of the vaccine, and it may consequently be underused in clinical practice. But the potential gain to the hiv positive patient is such that the vaccine should be offered to all hiv positive patients as soon as they present for medical care, irrespective of the stage of hiv disease. physicians and patients should be aware that the vaccine is not fully protective and that episodes of sepsis, pneumonia and meningitis could still be pneumococcal in origin and should be treated appropriately. awareness of the substantial risks of pneumococcal disease in hiv infected patients with prompt diagnosis and effective treatment is the most important strategy to decrease morbidity and mortality.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Should hyposplenic patients receive prophylaxis against bacterial infection?The risk of overwhelming septicaemia, most commonly due to encapsulated organisms, is well recognised post-splenectomy. Although a similar risk is documented in hyposplenic patients, many physicians do not routinely give prophylaxis here. We report the case of a 41 year old woman with adult onset coeliac disease who developed pneumococcal meningitis resulting in severe residual disability and suggest that prophylaxis should be given to such individuals who have evidence of reduced splenic function.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Overwhelming postsplenectomy infection in a patient with penicillin-resistant streptococcus pneumoniae.Overwhelming postsplenectomy infection is a fulminant process that carries a poor prognosis. streptococcus pneumoniae is the most likely organism to cause disease. infection with penicillin-resistant S pneumoniae is increasing; its prevalence ranges from 6.6% to 50% in the united states. If meningeal involvement with resistant pneumococcus is suspected, it should be treated with a third-generation cephalosporin and vancomycin hydrochloride. The long-term management of asplenic patients should focus on preventing infection. The current guidelines and recommendations for vaccination are reviewed. Educating these patients to contact their physician at the first sign of minor illness is also beneficial. The use of antibiotic prophylaxis remains a controversy and is best left to the discretion of the physician.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/6. Recurrent meningitis secondary to idiopathic oval window CSF leak.Bacterial meningitis remains a life-threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the histroy of a 12-year old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Mondini-type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle. A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed. Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube. Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. overall, a total of 36 operations was performed in the 15 patients reviewed. In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, expecially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effectively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |