Drug-induced aseptic meningitis in suspected central nervous system infections

This study presents eight patients with drug-induced aseptic meningitis (DIAM) admitted to our centre with an initial suspicion of central nervous system (CNS) infection. In all patients clinical findings, cerebrospinal fluid (CSF) examination, a cause-effect relationship according to the Naranjo adverse drug reactions probability scale and other diagnostic criteria required for DIAM recognition, were fulfilled. Nonsteroidal anti-inflammatory drugs were the most frequent cause of DIAM. In two cases, there was previous antimicrobial use. The time between use of the causative drug and onset of the symptoms ranged from 2 to 7 days. Clinical symptoms and CSF findings in patients with DIAM are indistinguishable from the early stage of infections of the CNS. Detailed anamnesis is essential, particularly related to medication use immediately prior to the appearance of symptoms of CNS impairment. In conclusion, the differential diagnosis of CNS infections should include DIAM.

[Usefulness of plasma C-reactive protein (CRP) estimation in patients with bacterial sepsis]

Between 1997-2000 there were 30 patients with bacterial sepsis treated at Department of Infectious Diseases of Silesian Medical University School in Bytom. Neisseria meningitidis (23.33%), Streptococcus pneumoniae (20%) and Staphylococcus aureus (3.33%) were most frequent etiological factors of the disease. The etiology of sepsis was not revealed in 53.34% of cases. Clinical state of patients was assessed using SSS and SAPS II score. All subjects were divided into two groups: group I--patients with septic syndrome symptoms (11 cases), group II--patients without septic syndrome symptoms (19 cases). The aim of the study was usefulness of plasma C-reactive protein estimation in the course of bacterial sepsis monitoring. Plasma CRP concentration was assessed by immunoturbidometric method (using RANDOX, UK kits). Blood samples were taken on th 1., 4. and 10. day of therapy. Plasma CRP levels were statistically significantly higher in patients of the group I in samples of the first and the second assay. CRP serum concentration correlated with severity of a patient's clinical state. Type of sepsis's etiological factor did not exert influence on plasma CRP level. In fatal cases high plasma CRP concentration was recorded during the whole time of hospitalization, whereas in cases of recovery fast decrease of this protein level was noted. The obtained result indicate, that estimation of plasma CRP concentration in patients with bacterial sepsis may be helpful in evaluation of clinical state severity, monitoring of the disease course as well as therapy efficacy.

[Cerebellitis in the course of varicella in a child: case report]

A case of cerebellitis as a complication of varicella in a 5-year old child was described. Special attention was paid to severe course of the disease and therapeutic problems. Actually available possibilities of active and passive prophylaxis of varicella-zoster virus infections were also discussed.

Influence of IFN-alpha on plasma erythropoietin levels in patients with hepatitis B virus-associated chronic active hepatitis

The influence of 3-month interferon-alpha (IFN-alpha) treatment on plasma erythropoietin (EPO) concentration in patients with chronic active hepatitis (CAH) induced by hepatitis B virus (HBV) infection was investigated. The study was carried out in 44 nonanemic patients divided into two groups: CAH B, 30 subjects not treated with IFN-alpha, and CAH B-IFN, 14 subjects treated with IFN-alpha for the first 3 months of the study (5 MU/m(2) body surface subcutaneously (s.c.) three times per week). In all patients, blood samples were taken at the beginning of the study (0) and after 1, 2, 3, 6, 9, and 12 months of observation. At the beginning, plasma EPO levels in the CAH B (27.8 +/- 2.21 mU/ml) and CAH B-IFN (27.3 +/- 3.04 mU/ml) groups did not differ significantly from each other and were significantly higher (p < 0.0001) than in healthy subjects (10.4 +/- 1.06 mU/ml). In patients in the CAH B group, plasma EPO concentrations did not change significantly during the whole observation period. In patients in the CAH B-IFN group, a transient, significant increase in plasma EPO level was found. The highest plasma EPO concentration in this group was noted after the third month of treatment (41.1 +/- 3.41 mU/ml). In conclusion, patients with CAH induced by HBV infection are characterized by increased plasma EPO concentrations, and IFN-alpha treatment in these patients causes a transient increase in the plasma EPO level.

[Tuberculous meningoencephalitis: a case report]

A case of tuberculous meningoencephalitis in 63-year old man is presented. Symptoms of the disease were found in the course of bone and pulmonary tuberculosis. Attention is paid to diagnostic data that may play an important role in diagnostics of the central nervous system tuberculosis. The therapy of tuberculous meningoencephalitis and the problem of potential Mycobacterium tuberculosis resistance to antituberculous drugs used up to the present are also discussed.

Epidemiology of hepatitis C virus infections in children

BACKGROUND

Epidemiological analysis of hepatitis C virus infections in children diagnosed and treated in the Hepatology Outpatient Clinic in Bytom between 1996 and 1999.

MATERIAL AND METHODS

The study comprised 62 children with detected serum presence of anti-HCV antibodies (ELISA method) and/or HCV-RNA (RT-PCR method). Risk factors for the infection were thoroughly analysed on the base of questionnaires.

RESULTS

It was established that in 55 (88.7%) children high probability of infection existed in connection with past hospitalization and applied diagnostic and therapeutic procedures, such as: transfusion of blood and its preparations (24.19%), surgical procedures (22.58%), hospital treatment without invasive procedures and blood transfusions (19.35%). Familial exposure was a risk factor in 4.84% of cases, while in 6.45% of cases there were no burdens in the history.

CONCLUSIONS

1. In the evaluated group of children HCV infection was iatrogenic in character in majority of cases. 2. Hospitalization, even without invasive procedures, may be an important risk factor for HCV infection. 3. Familial exposure seems to be of secondary importance in transmission of HCV infection.

Influence of HBV or HCV associated chronic liver diseases on the course and outcome of purulent, bacterial meningoencephalitis

BACKGROUND

Aim of the study was evaluation of HBV or HCV associated chronic liver diseases (HBV or HCV CHLD) influence on the course and outcome of purulent, bacterial meningoencephalitis (PBME), without symptoms of sepsis.

MATERIAL AND METHODS

Between 1995-99 there were 8 patients with PBME, with chronic HBV (5 subjects) or HCV (3 subjects) infection, treated in our centre; mean age 43 years. Str. pneumoniae and N. meningitidis were etiologic factors of PBME in 25% and 12.5% of patients, respectively. In 62.5% of cases etiology of PBME remained unknown. In 2 patients HBV or HCV CHLD was diagnosed before PBME (1 case--chronic active hepatitis, 1 case--postinflammatory liver cirrhosis). During hospitalization due to PBME in 4 patients liver cirrhosis was diagnosed on the base of clinical picture and laboratory results, in 2 patients chronic hepatitis B or C was subject to further diagnostic procedures.

RESULTS

In 7 subjects (87.5%) significant increase of AlAT and AspAT activity was recorded during acute phase of neuroinfection as compared to results preceding the hospitalization (to 300-400 U/l). Together with recovery from PBME decrease of aminotransferases activity was noted. In 1 fatal case high AlAT and AspAT activity was observed for the whole time of the disease. In 2 other patients with liver cirrhosis, classified into class A of Child-Turcott-Pugh classification at the beginning of PBME, after transient insignificant aminotransferases increase sudden decompensation of liver functions during recovery from PBME was observed. Both patients died due to haemorrhage from esophageal varices. In all patients with PBME and HBV or HCV CHLD inflammatory parameters of cerebrospinal fluid were increased for longer than average time. It was the reason of longer hospital stay. The influence of HBV or HCV CHLD on PBME outcome was not observed.

CONCLUSIONS

1. In patients with PBME concomitant HBV or HCV CHLD may exert negative influence on the course of neuroinfection and extend the period of hospitalization. 2. The increase of aminotransferases activity in these patients may suggest other hepatotropic virus superinfection and require further diagnostics. 3. In the case of HBV or HCV associated postinflammatory liver cirrhosis PBME may be connected with rapid liver disease progression and even the death of a patient.

[Purulent neuroinfections in the course of septicemia in the years 1988-1992: personal experience]

Between 1988 and 1992 thirty patients with purulent infections of central nervous system in the course of bacterial septicaemia were treated in the Intensive Care Unit of the I Clinic of Infectious Diseases of Silesian School of Medicine in Bytom. These cases made about 32% of the total bacterial neuroinfections treated in the Clinic during that time. Imminent or existing acute respiratory insufficiency, increasing intracranial pressure, intensification of haemorrhagic diathesis and imminent septic shock were the indications to the hospitalization in the Intensive Care Unit. Neisseria meningitidis, Streptococcus pneumoniae and Escherichia coli were the most often found etiological factors in subsequently 53.33%, 33.33% and 3.34% of patients. In 10% of cases the etiological factors remained unknown. Intratracheal intubations and/or tracheotomies were carried out in over 60% of patients. About 40% of cases required assisted or controlled mechanical ventilation with the aid of ventilator (on the average 5 days). Mean time of hospitalization in the Intensive Care Unit closed in the period of 7 days. Mortality in the analyzed group was 23.33% (7 cases). Bacterial septicaemia with purulent infections of central nervous system often leads to the directly life threatening complications. Hospitalization in conditions of Intensive Care Unit affords possibilities for effective treatment and improvement of prognosis in patients suffering from these diseases.