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Abe T, Maruyama S, Kaneyoshi K, Neshige S. Varicella-zoster Virus Meningitis Besides Bacterial Otitis. Intern Med 2024; 63:1329-1330. [PMID: 37779062 DOI: 10.2169/internalmedicine.2518-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Takafumi Abe
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Satoko Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Kenta Kaneyoshi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Shuichiro Neshige
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
- Epilepsy Center, Hiroshima University Hospital, Japan
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Vickery SB, Roach JK, Parsons C, Vickery PB. Possible levetiracetam-induced aseptic meningitis versus viral meningitis: Case report and literature review. Nurse Pract 2022; 47:32-37. [PMID: 35758918 DOI: 10.1097/01.npr.0000843216.79693.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
We report first viral meningitis associated with coronavirus disease 2019 (COVID-19) in a patient hospitalized at Imam Hassan Hospital in Bojnurd. The patient was a 9-year-old child with no history of internal disease who referred to the emergency with a complaint of fever, headache and low back pain, about 3 days after the onset of symptoms. finally, viral meningitis was diagnosed with COVID-19.
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Affiliation(s)
- Koroush Yousefi
- From the Department of Pediatrics, School of Medicine, Imam Hassan Hospital
| | | | - Zohre Abasi
- Department of Midwifery, School of Nursing and Midwifery
| | - Sajad Rahimi
- Imam Hassan Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Ali Khakshour
- Department of Pediatrics, School of Medicine, Eye Research Center, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Hoëffelin H, Marchetti P, Khamis J, Reginster P. [Cytotoxic lesion of the corpus callosum (CLOCC) in a context of viral meningitis]. Rev Med Liege 2020; 75:78-82. [PMID: 32030930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report the case of a young patient of 16 years admitted in the emergency department for headache, nausea and vomiting, of brutal installation. After clinico-biological confrontation, the diagnosis of viral meningitis (aseptic) was made. During the initial assessment several complementary examinations and various brain imaging exams (CT, MRI) were performed in the course of the treatment, showing a focal lesion of the splenium of the corpus callosum, with transient aspect and spontaneously resolving during iterative control. MRI is the modality that formally revealed this callosal lesion. In terms of signaling behavior, this lesion is characterized by an hyperintensity on FLAIR/T2 weighted sequence and a restriction of diffusion (cytotoxic edema). No other signaling abnormalities or malformative lesions are found. The iconographic diagnosis of «cytotoxic lesions of the corpus callosum» (CLOCC for «Cytotoxic lesion of the corpus callosum») was made.
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Affiliation(s)
- H Hoëffelin
- Service d'Imagerie médicale, CHC Liège, Belgique
| | - P Marchetti
- Service d'Imagerie médicale, CHC Liège, Belgique
| | - J Khamis
- Service d'Imagerie médicale, CHC Liège, Belgique
| | - P Reginster
- Service d'Imagerie médicale, CHC Liège, Belgique
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Bienkowski C, Kowalczyk M, Talarek E, Pokorska-Spiewak M, Kierdaszuk B, Marczynska M. Meningitis and Ramsay-Hunt syndrome in a 17-year old girl. Neuro Endocrinol Lett 2019; 40:149-151. [PMID: 31816219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Ramsay Hunt syndrome (RHS) is a rare manifestation of varicella-zoster virus (VZV) reactivation in geniculate ganglion. It usually manifests with a characteristic triad of symptoms including ipsilateral ear pain, vesicles in the external auditory canal, and facial nerve palsy. CASE We present a case report showing RHS additionally manifested by meningitis and involvement of VIII cranial nerve. Clinical course was complicated by acute kidney injury induced by acyclovir therapy. RESULTS Despite the involvement of the geniculate ganglion and vestibulocochlear nerve in the course of herpes zoster, and the occurrence of acute kidney injury, the patient fully recovered. CONCLUSIONS A complete recovery of cranial nerves VII and VIII in the course of RHS can be achieved.
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Affiliation(s)
- Carlo Bienkowski
- Student's Scientific Group at Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
| | - Monika Kowalczyk
- Student's Scientific Group at Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
| | - Ewa Talarek
- Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
| | | | | | - Magdalena Marczynska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
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Haydar SM, Hallit SR, Hallit RR, Salameh PR, Faddoul LJ, Chahine BA, Malaeb DN. Adherence to international guidelines for the treatment of meningitis infections in Lebanon. Saudi Med J 2019; 40:260-265. [PMID: 30834421 PMCID: PMC6468200 DOI: 10.15537/smj.2019.3.23965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives: To assess meningitis treatment in Lebanon’s compatibility with the Infectious Diseases Society of America (IDSA) guidelines and the effect of non-compliance on mortality. Methods: This is a retrospective study, conducted in 5 Lebanese hospitals, and enrolling all patients diagnosed with meningitis who presented to the involved hospitals from January 2008 to December 2016. Results: A total of 252 participants were enrolled in the study. Of these patients, 205 (82.7%) were diagnosed with viral meningitis and 47 (17.3%) with bacterial meningitis, which was confirmed using laboratory tests. For patients with viral meningitis, 128 (62.4%) remained on the initial prescribed antibiotics despite the negative cerebrospinal fluid (CSF) and blood culture results. For bacterial meningitis patients, 30.8% received treatment regimen incompatible with the IDSA guidelines. The most common reason for the treatment incompatibility was the definitive drug choice after the culture results (49.1%) and the least common reason was inappropriate hospital stay days (25.9%). The mortality rate was 13.5%. Having low proteins values in the CSF (odds ratio=0.095) was associated with lower mortality compared to patients with normal protein values. Conclusion: This study shows a high percentage of inappropriate treatment in Lebanese hospitals despite these hospitals having adopted international treatment guidelines. This inappropriate management was associated with an increasing rate of mortality and neurological complications.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Cerebrospinal Fluid Proteins
- Child
- Child, Preschool
- Female
- Guideline Adherence
- Hospitals/standards
- Humans
- Infant
- Infant, Newborn
- Lebanon/epidemiology
- Male
- Medication Errors
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/drug therapy
- Meningitis, Bacterial/mortality
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/complications
- Meningitis, Viral/drug therapy
- Meningitis, Viral/mortality
- Middle Aged
- Practice Guidelines as Topic
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Sahar M Haydar
- School of Pharmacy, Lebanese University, Beirut, Lebanon. E-mail.
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Unai Y, Sato K. [A case of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing triggered by mumps meningitis in a patient with recurrent primary stabbing headache]. Rinsho Shinkeigaku 2018; 58:178-181. [PMID: 29491331 DOI: 10.5692/clinicalneurol.cn-001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 32-year-old man with a 16-year history of recurrent primary stabbing headache was admitted to our hospital, owing to mumps meningitis. On day 2 of admission, he began experiencing episodes of unbearable intermittent stabbing pain, each lasting few seconds, with conjunctival injection and tearing, on the temporal side of the left orbit. We suspected trigeminal autonomic cephalgias, and administered non-steroidal anti-inflammatory drugs (NSAIDs), oxygen, and sumatriptan; however, the pain episodes persisted. Subsequently, after the start of intravenous lidocaine administration, the pain episodes stopped. We diagnosed a short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT), triggered by mumps meningitis. This is a valuable case report, involving a patient with a history of primary stabbing headache who was diagnosed with SUNCT triggered by mumps meningitis.
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Affiliation(s)
- Yuki Unai
- Department of Neurology, Tokushima Prefectural Central Hospital
| | - Kenta Sato
- Department of Neurology, Tokushima Prefectural Central Hospital
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Takeshima S, Shiga Y, Himeno T, Tachiyama K, Kamimura T, Kono R, Takemaru M, Takeshita J, Shimoe Y, Kuriyama M. [Clinical, epidemiological and etiological studies of adult aseptic meningitis: Report of 11 cases with varicella zoster virus meningitis]. Rinsho Shinkeigaku 2017; 57:492-498. [PMID: 28804114 DOI: 10.5692/clinicalneurol.cn-001054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We treated 11 cases (52.7 ± 14.9 years, all male) with varicella zoster virus (VZV) meningitis and 437 cases with adult aseptic meningitis from 2004 to 2016. The incidence rate of adult VZV meningitis in the cases with aseptic meningitis was 2.5%. Herpes zoster infections are reported to have occurred frequently in summer and autumn. VZV meningitis also occurred frequently in the similar seasons, in our patients. The diagnoses were confirmed in 9 cases with positive VZV-DNA in the cerebrospinal fluid and in 2 cases with high VZV-IgG indexes (> 2.0). For diagnosis confirmation, the former test was useful for cases within a week of disease onset, and the latter index was useful for cases after a week of disease onset. Zoster preceded the meningitis in 8 cases, while the meningitis preceded zoster in 1 case, and 2 cases did not have zoster (zoster sine herpete). Two patients were carriers of the hepatitis B virus, 1 patient was administered an influenza vaccine 4 days before the onset of meningitis, and 1 patient was orally administered prednisolone for 2 years, for treatment. Their immunological activities might have been suppressed. The neurological complications included trigeminal neuralgia, facial palsy (Ramsay Hunt syndrome), glossopharyngeal neuralgia, and Elsberg syndrome. Because the diseases in some patients can become severe, they require careful treatment.
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Affiliation(s)
- Shinichi Takeshima
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: Department of Rehabilitation Medicine, Showa University School of Medicine
| | - Yuji Shiga
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Keisuke Tachiyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: Hiroshima City Hiroshima Citizens Hospital
| | - Teppei Kamimura
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: National Central and Cardiovascular Center
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Jun Takeshita
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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Zammarchi L, Montagnani F, Tordini G, Gotuzzo E, Bisoffi Z, Bartoloni A, De Luca A. Persistent strongyloidiasis complicated by recurrent meningitis in an HTLV seropositive Peruvian migrant resettled in Italy. Am J Trop Med Hyg 2015; 92:1257-1260. [PMID: 25846292 PMCID: PMC4458834 DOI: 10.4269/ajtmh.14-0716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022] Open
Abstract
We describe a case of persistent strongyloidiasis complicated by recurrent meningitis, in a human T cell lymphotropic virus type 1 (HTLV-1) seropositive Peruvian migrant adult resettled in Italy. He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of Escherichia coli and Enterococcus faecium in two cases. He had been previously treated with several antihelmintic regimens not including ivermectin, without eradication of strongyloidiasis, and he had never been tested for HTLV before. During the described episode, the patient was treated for meningitis with broad-spectrum antibiotic therapy and 200 μg/kg/dose oral ivermectin once daily on day 1, 2, 15 and 16 with full recovery and no further episodes of meningitis. The presented case underlines several critical points concerning the management of poorly known neglected diseases such as strongyloidiasis and HTLV infection in low-endemic areas. Despite several admissions for meningitis and strongyloidiasis, the parasitic infection was not adequately treated and the patient was not previously tested for HTLV. The supply of ivermectin and the choice of treatment scheme was challenging since ivermectin is not approved in Italy and there are no standardized guidelines for the treatment of severe strongyloidiasis in HTLV seropositive subjects.
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Affiliation(s)
| | | | | | | | | | - Alessandro Bartoloni
- *Address correspondence to Alessandro Bartoloni, Largo Brambilla 3, 50134 Florence, Italy. E-mail:
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Weatherhead JE, Miller VE, Garcia MN, Hasbun R, Salazar L, Dimachkie MM, Murray KO. Long-term neurological outcomes in West Nile virus-infected patients: an observational study. Am J Trop Med Hyg 2015; 92:1006-1012. [PMID: 25802426 PMCID: PMC4426557 DOI: 10.4269/ajtmh.14-0616] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/19/2014] [Indexed: 11/07/2022] Open
Abstract
The Houston West Nile Cohort (HWNC) was founded in 2002 when West Nile virus (WNV) reached Houston, TX. The long-term outcomes following WNV infection are still mostly unknown, though neurological abnormalities up to 1 year postinfection have been documented. We report an observational study of neurological abnormalities at 1-3 and 8-11 years following WNV infection in the HWNC. We conducted standard neurological examinations at two separate time points to assess changes in neurological status over time. The majority of patients (86%, 30/35) with encephalitis had abnormal neurological exam findings at the time of the first assessment compared with uncomplicated fever (27%, 3/11) and meningitis (36%, 5/14) cases. At the time of the second assessment, 57% (4/7) of West Nile fever (WNF), 33% (2/6) of West Nile meningitis (WNM), and 36% (5/14) of West Nile encephalitis (WNE) had developed new neurological complications. The most common abnormalities noted were tandem gait, hearing loss, abnormal reflexes, and muscle weakness. Long-term neurological abnormalities were most commonly found in patients who experienced primary WNV encephalitis. New abnormalities may develop over time regardless of initial clinical infection. Future studies should aim to differentiate neurological consequences due to WNV neuroinvasive infection versus neurological decline related to comorbid conditions.
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Affiliation(s)
| | | | | | | | | | | | - Kristy O. Murray
- *Address correspondence to Kristy O. Murray, Baylor College of Medicine, Texas Children's Hospital Feigin Center, BCM 320, Houston, TX 77030. E-mail:
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12
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Brandt C. [Virus in the brain]. Ugeskr Laeger 2015; 177:V66790. [PMID: 25749114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Christian Brandt
- Lunge- og Infektionsmedicinsk Afdeling, Nordsjællands Hospital, Hillerød, Dyrehavevej 29, 3400 Hillerød.
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Escalza-Cortina I, Azkune-Calle I, Rodriguez-Sainz A, Gomez-Beldarrain M, Vicente-Olabarría I, Garcia-Monco JC. Pearls & Oy-sters: Chronic mumps meningoencephalitis with low CSF glucose and acute hydrocephalus in an adult. Neurology 2014; 82:e41-3. [PMID: 24491977 DOI: 10.1212/wnl.0000000000000081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ines Escalza-Cortina
- From the Service of Neurology (I.E.-C., I.A.-C., A.R.-S., M.G.-B., J.C.G.-M.) and OSATEK-Magnetic Resonance Imaging Unit (I.V.-O.), Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
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Rollino C, Balbiano R, Caramello P, Roccatello D. [The use of tolvaptan in a case of severe hyponatriemia in SIADH during meningitis]. G Ital Nefrol 2013; 30:gin/00101.8. [PMID: 24402662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Vaptans, vasopressin V2 receptor antagonists, are new drugs indicated in the treatment of Inappropriate ADH Secretion Syndrome (SIADH). We report a case of SIADH in a patient affected by AIDS. During a hospitalization for an ongoing CMV meningitis she developed a severe hyponatremia (114 mEq/L), which was initially treated with restriction of free water. When the diagnosis of SIADH was done (plasma Osmolarity 240 mOsm/kg, urinary sodium >30 mEq/24 h, normal volemia, lack of hypocorticosurrenalism and hypothyroidism), tolvaptan was given at the dose of 15 mg/day. Important fluctuations of plasma Na were observed thereafter (119-143 mEq/L). The progressive reduction of the drug (to 2 mg/die) allowed a stable correction of natremia. Unconsciousness determined the impossibility of the patient to freely access to water, thus explaining the fluctuations of natremia and the difficult management of the drug. Only a posology reduction to doses lower than those available for sale allowed a stable correction of natremia.
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Vindenes T, Crowl G, Perera BM, Schleiter G. The elusive diagnosis: recurrent benign lymphocytic meningitis. Conn Med 2013; 77:477-479. [PMID: 24156176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Recurrent benign lymphocytic meningitis (RBLM) or Mollaretmeningitis is a rare disease with a prevalence of 1-2.2/100,000 population. It is characterized by recurrent episodes of aseptic meningitis. The diagnosis is made via history fitting Bruyn's criteria, and confirmatory detection of HSV-2 in cerebrospinal fluid (CSF) via polymerase chain reaction (PCR). CASE A 59-year-old female with a past medical history (PMH) of rheumatoid arthritis in remission and 11 prior episodes of aseptic meningitis presented with sudden and severe headache, photophobia, nausea, vomiting, and meningismus without focal findings. CSF analysis revealed aseptic meningitis with Herpes simplex 2 virus (HSV-2) present by PCR. CONCLUSION RBLM remains a rare and elusive diagnosis but PCR technology has made it easier to diagnose. We present a 59-year-old female with classic features of RBLM, now suffering a 12th episode of aseptic meningitis. Heightened awareness of RBLM among clinicians may allow for an earlier diagnosis, reduced use of unnecessary antibiotics, shortened hospitalizations, and lower costs.
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Affiliation(s)
- Tine Vindenes
- Western Connecticut Health Network (WCHN), Department of Internal Medicine, Danbury Hospital, Danbury, USA.
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Brouwer MC, Jim KK, Benschop KS, Wolthers KC, van der Ende A, de Jong MD, van de Beek D. No evidence of viral coinfection in cerebrospinal fluid from patients with community-acquired bacterial meningitis. J Infect Dis 2013; 208:182-4. [PMID: 23559461 DOI: 10.1093/infdis/jit140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vâţă A, Luca CM, Duca E, Irina T, Manciuc C, Vâţă LG, Dorobăţ C. Viral meningitis admitted to an infectious diseases hospital: a retrospective case series. Rev Med Chir Soc Med Nat Iasi 2013; 117:476-482. [PMID: 24340533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Given its epidemic potential and development of severe forms of disease, viral meningitis (VM) is a serious public health problem. AIM to characterize the main clinical, epidemiologic features, the etiology and treatment of VM cases admitted to the Iasi Infectious Diseases Hospital, in 2012. MATERIAL AND METHODS We retrospectively analyzed the medical records of the patients admitted for viral meningitis at the Iasi "St. Parascheva" Infectious Diseases Hospital in the interval January 1- December 31, 2012 (98 cases). The etiologic diagnosis was made by determining the IgM/IgG antibodies against Coxsackie virus and/or West Nile virus in blood/CSF. RESULTS There was a fourfold increase in the number of cases as compared to the average for the years 2009-2011. Most cases (73.5%) were children aged 1 to 14 years. 61.8% of patients were males, 51.7% from urban areas. The most common symptom was headache (85.7%), followed by fever (77.6%), and vomiting (66.3%). Neck stiffness was absent in 28.6% cases. In43.5% of the 39 patients serologically investigated a Coxsackie virus infection was confirmed and 1/20 was positive for West Nile virus; three varicella-zoster virus infections and one mumps infection were diagnosed clinically. 68.3% of the patients received first-line antibiotic treatment. CONCLUSIONS The illness mainly affected children, fever and neck stiffness being sometimes absent. The etiology was known in 22.4% of cases; enter viruses being the most frequent causative agent. Most patients received antibiotic therapy. The course was favorable in all cases.
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Affiliation(s)
- A Vâţă
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa" - Iaşi
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Magazzini S, Nazerian P, Vanni S, Paladini B, Pepe G, Casanova B, Crugnola C, Grifoni S. Clinical picture of meningitis in the adult patient and its relationship with age. Intern Emerg Med 2012; 7:359-64. [PMID: 22419148 DOI: 10.1007/s11739-012-0765-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient's history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14-90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient's age (r = -0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.
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Affiliation(s)
- Simone Magazzini
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Affiliation(s)
- Erik B Hysinger
- Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
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Abstract
A 42-year-old man presented with fever, headache and liver dysfunction, and was diagnosed as having aseptic meningitis by lumbar puncture. The PCR detected Epstein-Barr virus (EBV)-DNA in the peripheral blood and cerebrospinal fluid. About 20 days after onset, the patient presented with hearing impairment in the right ear, which was confirmed by a pure tone audiogram. The hearing acuity improved after the initiation of hydrocortisone sodium phosphate. We presume that the hearing impairment was due to auditory nerve neuritis related to extension of inflammation of the meninges. This is the first reported case of EBV-associated meningitis showing hearing impairment.
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Damsgaard J, Hjerrild S, Renvillard SG, Leutscher PDC. [Neuropsychiatric sequelae of viral meningitis in adults]. Ugeskr Laeger 2011; 173:2560-2563. [PMID: 21985833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Viral meningitis is considered to be a benign illness with only mild symptoms. In contrast to viral encephalitis and bacterial meningitis, the prognosis is usually good. However, retrospective studies have demonstrated that patients suffering from viral meningitis may experience cognitive impairment following the acute course of infection. Larger controlled studies are needed to elucidate the potential neuropsychiatric adverse outcome of viral meningitis.
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Affiliation(s)
- Jesper Damsgaard
- Infektionsmedicinsk Afdeling Q, Aarhus Universitetshospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
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Hai J, Zhang L, Wan JF, Su SH, Wang F, Zhang GY. A dural arteriovenous fistula in cavernous sinus developed from viral meningitis. Acta Neurol Belg 2011; 111:146-148. [PMID: 21748936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although hormonal influences, inflammation, trauma, sinus thrombosis, venous hypertension, and congenital origin have been proposed as sources of dural arteriovenous fistulas (DAVFs) in cavernous and sigmoid sinuses, the etiology of these lesions remains controversial. We present a case with a cavernous sinus DAVF developed from viral meningitis which has not been previously described. A 24-year-old male was admitted to our institute because of periorbital pain, decreased vision, pulsatile tinnitus, chemosis, and exophthalmos on the right side after he had suffered viral meningitis four months before. Cerebral angiography demonstrated a cavernous sinus DAVF, which was successfully obliterated with several platinum coils using a transvenous approach. The viral meningitis most likely caused the inflammation, that may be responsible for the occurrence of the cavernous sinus DAVF. Prompt treatment for inflammation may help to prevent the development of DAVFs.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, Shanghai, China.
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Affiliation(s)
- Amie Nuttall
- Fairfield General Hospital, Pennine Acute Hospitals NHS Trust, Bury
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Abstract
CONTEXT Data from previous retrospective studies and case reports have suggested that infectious diseases of the central nervous system could cause pituitary deficiency. OBJECTIVE The aim of this prospective study was to investigate pituitary function in patients admitted with infectious meningitis during the acute phase and after 12 months. DESIGN Sixteen patients were studied. Basal pituitary function was assessed within 24 h of admission. Twelve of these patients underwent both basal and stimulated (insulin tolerance test) pituitary testing after 12 months. RESULTS During the acute phase, five patients (31.25%) showed apparent pituitary hormone deficiencies: two patients with gonadotropic and three patients with somatotropic deficiency. The exact status of corticosteroid sufficiency could not be defined in four patients, because no dynamic test was performed in the acute phase. In addition, seven patients (44%) had probable low T(3) syndrome. At 12 months, five patients (31.25%), two with viral and three with bacterial meningitis, had at least one anterior pituitary hormone deficiency. Two patients had isolated corticotropic and one isolated somatotropic deficiency. Combined corticotropic and somatotropic deficiencies were detected in two patients. New-onset deficiencies accounted for four of those five patients, whereas one patient demonstrated persisting somatotropic deficiency. All cases of low T(3) syndrome resolved at 12 months. CONCLUSIONS Isolated or combined pituitary deficiencies, which could present at the acute phase and/or occur at a later stage, can develop in a considerable proportion of patients after acute infectious meningitis.
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Affiliation(s)
- Aristotelis Tsiakalos
- Pathophysiology Department, Athens University Medical School, Mikras Asias 75, 11527 Athens, Greece.
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Naito M, Johkura K, Momoo T, Nomiya T, Kudo Y, Kuroiwa Y. Dementia and capsular genu ischemia in patients with severe bacterial meningitis. Neurol Sci 2009; 31:133-6. [PMID: 19838622 DOI: 10.1007/s10072-009-0168-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 09/30/2009] [Indexed: 12/12/2022]
Abstract
Infarction in the genu of the internal capsule causes dementia that is characterized by abulia, lethargy and memory loss without obvious motor palsy (capsular genu syndrome). We found infarction or decreased cerebral blood flow in the genu of the internal capsule in 6 of 13 patients with severe bacterial meningitis. Four of these six patients developed post-meningitis dementia, characterized by abulia, lethargy, and memory loss. Of 24 patients with viral meningitis, none developed capsular genu ischemia or post-meningitis dementia. In patients with severe bacterial meningitis, capsular genu ischemia may play some role in the development of post-meningitis dementia. In patients with viral meningitis, absence of such ischemia may explain, at least in a part, the rarity of post-meningitis dementia.
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Affiliation(s)
- Makoto Naito
- Department of Neurology, Kanagawa Prefectural Ashigara Kami Hospital, Matsuda-cho, Japan
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26
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Argyriou AA, Tsota I, Solomou E, Marangos M, Kalogeropoulou C, Petsas T, Dimopoulos PA, Chroni E. Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis: Case report and review of the literature. ACTA ACUST UNITED AC 2009; 38:63-6. [PMID: 16338841 DOI: 10.1080/00365540500264019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present a case of herpetic meningoencephalitis confirmed by PCR in a 22-y-old male, with accompanying appearance of a large intracerebral haematoma as a complication. Despite the impressive imaging findings, the final outcome of the patient's progress was favourable.
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Affiliation(s)
- Andreas A Argyriou
- Department of Neurology, Division of Infectious Diseases of the University Hospital of Patras, Rion-Patras, Greece.
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Ito Y, Yamamoto T, Ninomiya M, Mizoi Y, Itokawa K, Tamura N, Araki N, Shimazu K. Secondary SUNCT syndrome caused by viral meningitis. J Neurol 2009; 256:667-8. [PMID: 19444540 DOI: 10.1007/s00415-009-0104-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 08/08/2008] [Accepted: 09/03/2008] [Indexed: 11/29/2022]
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Donovan C. Mind over matter. Interview by Mary-Claire Mason. Nurs Stand 2009; 23:25. [PMID: 19263902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The after-effects of meningitis can be long-term and profound. But the Meningitis Trust is there to help.
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Martínez-García FA, Moreno-Docón A, Segovia-Hernández M, Fernández-Barreiro A. [Deafness as a sequela of Toscana virus meningitis]. Med Clin (Barc) 2008; 130:639. [PMID: 18482536 DOI: 10.1157/13120347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zajkowska J, Moniuszko A, Czupryna P, Kuśmierczyk J, Pancewicz SA. [Encephalomeningitis caused by Listeria monocytogenes in patient infected by TBE virus--case report]. Przegl Epidemiol 2008; 62 Suppl 1:158-162. [PMID: 22320051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The epidemiology of listeriosis is constantly changing towards higher incidence. The most endangered group of patients are people with immunodeficiency caused by coexisting diseases. In these cases listeriosis may take a very severe course. In this paper we present a case of a 76 year old female who suffered from encephalomeningitis caused by Listeria monocytogenes and additionally was infected by tick borne encephalitis virus and Borrelia burgdorferi.
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31
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Affiliation(s)
- Adrienne Ruth
- Emory University School of Medicine, Atlanta, GA 30322, USA
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Abstract
Enteric fevers are caused by invasive strains of Salmonella. Classic enteric fever is caused by S. typhi and usually less severe enteric fevers are caused by S. paratyphi A, B, or C. We present a case of S. paratyphi A enteric fever aseptic meningitis. Headache was so prominent in the case presented that a lumbar puncture was performed to rule out meningitis. Rose spots were not apparent in this dark-skinned patient. Our patient did not have increased serum transaminases and did not have leukopenia, which are common findings in enteric fever. The absence of these findings and the relative bradycardia may be explained by the antimicrobial therapy the patient received before admission. After ruling out malaria, clinicians should suspect enteric fever in patients recently returning from endemic areas, in patients presenting with acute fevers without localizing signs.
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Affiliation(s)
- Deepa Kudalkar
- Infectious Disease Division, Department of Medicine, Winthrop-University Hospital, Mineola, NY 11501, USA
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Schmidt H, Cohrs S, Heinemann T, Goerdt C, Djukic M, Heimann B, Wallesch CW, Nau R. Sleep disorders are long-term sequelae of both bacterial and viral meningitis. J Neurol Neurosurg Psychiatry 2006; 77:554-8. [PMID: 16543543 PMCID: PMC2077506 DOI: 10.1136/jnnp.2005.071142] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many bacterial meningitis patients experience neurological or neuropsychological sequelae, predominantly deficits in short-term memory, learning, and attention. Neuropsychological symptoms after viral meningitis are observed less frequently. Sleep disturbance has been reported after both viral and bacterial meningitis. OBJECTIVES To examine systematically the frequency and extent of sleep disturbance in meningitis patients. METHODS Eighty six viral or bacterial meningitis (onset of acute disease at least 1 year previously) patients were examined using two standardised questionnaires (Schlaffragebogen B and the Pittsburgh Sleep Quality Index, PSQI) in conjunction with a standardised neurological examination, and compared to a control group of 42 healthy age-matched volunteers. RESULTS Patients after both viral and bacterial meningitis described their sleep as reduced in quality and less restful than that of healthy control subjects; both patient groups had a pathological mean PSQI total score. Impaired sleep scores after meningitis were not correlated to either the Glasgow Coma Scale or the Glasgow Outcome Scale. Moreover, no relationship between residual neurological dysfunction or depressivity and sleep quality was observed. CONCLUSIONS Impaired sleep is a long-term consequence of meningitis. Additional, so far undetermined, factors other than the severity of concomitant neurological deficits are responsible for the development of this sequela.
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Affiliation(s)
- H Schmidt
- Department of Neurology, University of Goettingen, Goettingen, Germany.
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Abstract
BACKGROUND Clinical manifestations caused by parvovirus B19 (PVB19) are various and depend on the age and immunity of an infected person. In children, the most frequent clinical manifestation of parvovirus B19 primary infection is erythema infectiosum (EI). CASE REPORT In this case report we presented a 12-year-old patient with 2 clinical syndromes: erythema infectiosum and serous meningitis. Erythema infectiosum was manifested as fever, typical skin lesions ("slapped cheeks"), erythematous macules and papules confluent with reticular appearance on the extremities and the trunk. Serous meningitis had a mild course with an increased number of lymphocytes (120/ mm3) and the mildly increased level of proteins (0.75 g/l). The serological examination showed the presence of IgM and IgG antibodies against parvovirus B19 in serum, as well as in cerebrospinal fluid (CSF). The reduction of serum/CSF ratio of IgG antibodies was present. The symptomatic therapy was used in the treatment. The course and the prognosis were benign. CONCLUSION Human PVB19, although non-specifically associated with CNS diseases could be an etiological factor that might cause serous meningitis. So, it should be considered in different diagnosis in patients with aseptic meningitis, especially during the outbreaks of erythema infectiosum.
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Affiliation(s)
- Predrag Canović
- Klinicki centar Kragujevac, Infektivna klinika, Kragujevac, Srbija i Crna Gora.
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Montgomery SP, Chow CC, Smith SW, Marfin AA, O'Leary DR, Campbell GL. Rhabdomyolysis in patients with west nile encephalitis and meningitis. Vector Borne Zoonotic Dis 2006; 5:252-7. [PMID: 16187894 DOI: 10.1089/vbz.2005.5.252] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Since 1999, more than 6,500 cases of West Nile virus neuroinvasive disease (WNND) have been reported in the United States. Patients with WNND can present with muscle weakness that is often assumed to be of neurological origin. During 2002, nearly 3,000 persons with WNV meningitis or encephalitis (or both) were reported in the United States; in suburban Cook County, Illinois, with 244 persons were hospitalized for WNV illnesses. The objective of this investigation was to describe the clinical and epidemiological features of identified cases of WNV neuroinvasive disease and rhabdomyolysis. Public health officials investigated patients hospitalized in Cook County, and identified a subset of WNV neuroinvasive disease patients with elevated creatine kinase levels. Cases were defined as hospitalized persons with a WNV infection, encephalitis or meningitis, and rhabdomyolysis. Retrospective medical record reviews were conducted and data was abstracted with a standardized data collection instrument. Eight patients with West Nile encephalitis and one with West Nile meningitis were identified with rhabdomyolysis. Median age of the nine patients was 70 years (range, 45-85 years), and eight were men. For all nine patients, the peak CK level was documented a median of 2 days after hospitalization (range, 1-24 days). Median CK level during hospitalization for all case-patients was 3,037 IU (range, 1,153-42,113 IU). Six patients had history of recent falls prior to admission. Although the temporal relationship of rhabdomyolysis and neurological WNV illness suggested a common etiology, these patients presented with complex clinical conditions which may have led to development of rhabdomyolysis from other causes. The spectrum of WNV disease requires further investigation to describe this and other clinical conditions associated with WNV infection.
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Affiliation(s)
- Susan P Montgomery
- Arbovirus Diseases Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, Colorado, USA.
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Abstract
The human neurotropic JC virus (JCV) is most commonly acquired during childhood, and, because no clinical illness has been associated with primary infection, is presumed to be asymptomatic. In the immunocompromised host, JCV is responsible for progressive multifocal leukoencephalopathy (PML). We describe a patient with longstanding systemic lupus erythematosus who presented with acute meningitis without encephalitis or PML. JCV was the only pathogen found in the cerebrospinal fluid suggesting a primary infection or symptomatic reactivation. Our observation demonstrates the expanding clinical importance of JCV in autoimmune diseases, and diagnostic tests for JCV should be included in the investigative work-up for meningitis or encephalitis in these patients.
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Affiliation(s)
- J-F Viallard
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Pessac Cedex, France.
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Abstract
A 34-year-old woman presented to hospital with symptoms of meningitis, later confirmed to be due to herpes simplex virus type 2. She developed hydrocephalus on day 2 of her admission. We describe the first case of hydrocephalus associated with herpes simplex type 2 meningitis in an adult.
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Affiliation(s)
- Elaine Yap
- Department of Infectious Diseases, Auckland City Hospital, Grafton, New Zealand.
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Brivet FG, Ducuing S, Jacobs F, Chary I, Pompier R, Prat D, Grigoriu BD, Nordmann P. Accuracy of clinical presentation for differentiating bacterial from viral meningitis in adults: a multivariate approach. Intensive Care Med 2005; 31:1654-60. [PMID: 16244879 DOI: 10.1007/s00134-005-2811-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Accepted: 08/11/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether bacterial (BM) and viral (VM) meningitis can be differentiated based on initial clinical presentation. DESIGN AND SETTING Retrospective cohort study in a medical emergency department and intensive care unit in a university hospital. PATIENTS 144 adults, including 90 with confirmed BM and 54 unpretreated VM. MEASUREMENTS AND RESULTS Symptoms, examination findings, paraclinical data, and clinical outcome were assessed. Severity was defined by the presence at referral of one of the following criteria: altered consciousness, seizures, focal neurological findings, and shock. After univariate analyses we performed stepwise logistic regression to determine predictors for BM available at referral (except for CSF Gram stain) and logistic regression using previously validated CSF cutoffs. Univariate methods identified the presence of one sign of severity as the most important predictor for BM (sensitivity 0.989, specificity 0.981, positive predictive value 0.989, negative predictive value 0.981, odds ratio 4,770) and showed that CSF results differ in BM and in VM (except for CSF glucose). Logistic regression analysis revealed severity and CSF absolute neutrophil count as the two predictors of BM (R2=0.876). Logistic analysis showed that BM was related to severity (beta=6.46+/-1.27) and a CSF absolute neutrophil count above 1,000/mm3 whereas CSF glucose below 2 mmol/l and CSF protein higher than 2 g/l were not predictive. CONCLUSIONS The presence of at least one sign of severity at referral and a CSF absolute neutrophil count above 1,000/mm3 mm are predictive of BM.
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Affiliation(s)
- François G Brivet
- Medical Intensive Care Unit, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, 157 Rue de la Porte de Trivaux, 92141, Clamart, France.
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Jaïdane H, Chouchane C, Gharbi J, Chouchane S, Merchaoui Z, Ben Meriem C, Aouni M, Guediche MN. [Neuromeningeal enterovirus infections in Tunisia: epidemiology, clinical presentation, and outcome of 26 pediatric cases]. Med Mal Infect 2005; 35:33-8. [PMID: 15695031 DOI: 10.1016/j.medmal.2004.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2004] [Accepted: 09/13/2004] [Indexed: 11/17/2022]
Abstract
UNLABELLED Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines. OBJECTIVE The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS. METHOD AND PATIENTS We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR. RESULTS This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case). CONCLUSION This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.
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Affiliation(s)
- H Jaïdane
- Laboratoire des maladies transmissibles et substances biologiquement actives, faculté de pharmacie de Monastir, 5000 Monastir, Tunisie.
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Vallet S, Tempescul A, Tran A, Legrand-Quillien MC, Narbonne V, Berthou C. Cytomegalovirus-associated meningoradiculoneuritis after treatment of mantle cell lymphoma with a combination of chemotherapy and rituximab. Ann Hematol 2005; 84:545-7. [PMID: 15789227 DOI: 10.1007/s00277-005-1038-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 03/02/2005] [Indexed: 10/25/2022]
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Abstract
INTRODUÇÃO: Déficit auditivo tem sido considerado uma das principais manifestações tardias das meningites, sobretudo quando esta ocorre nos dois primeiros anos de vida. No país, poucos são os estudos relatando a evolução de crianças acometidas por meningite e a percentagem e gravidade dos transtornos auditivos e seqüelas neurológicas após a alta hospitalar. OBJETIVO: Caracterizar as principais seqüelas auditivas e neurológicas, delineando o perfil do comprometimento auditivo encontrado cinco anos após a infecção do sistema nervoso central. MÉTODO: Foram incluídas crianças com idade entre 5 e 7 anos, admitidas no Hospital Couto Maia no ano de 1997, e que tiveram diagnóstico de meningite com idade inferior a dois anos. RESULTADOS: 19 crianças passaram pela avaliação neurológica e auditiva. A idade média foi 6 anos e 68,42% eram do sexo masculino. Quanto à etiologia, 52,63% piogênica, 42,1%viral, 5,26% tuberculosa. Alterações auditivas ocorreram em 26,31% da população. CONCLUSÃO: Distúrbios auditivos trazem implicações acadêmicas e sociais às crianças afetadas, especialmente aquelas em idade escolar. Destacamos a necessidade de monitoramento audiológico de todas as crianças com história prévia de meningite.
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Affiliation(s)
- Luzia Poliana Anjos
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, BA, Brazil
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42
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Affiliation(s)
- Nicholas Davies
- Department of Clinical Neurosciences, Hodgkin Building, Guy's Hospital, London SE1 1UL, UK
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43
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Listernick R. A 3-year-old boy with previous illness, signs of meningitis, and seizures. Pediatr Ann 2004; 33:287-8, 291-4. [PMID: 15162635 DOI: 10.3928/0090-4481-20040501-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Robert Listernick
- Feinberg School of Medicine, Northwestern University, Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children's Memorial Hospital, Chicago, Illinois, USA
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44
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Abstract
An 8-week-old female infant presented with a history of active varicella complicated by Escherichia coli sepsis, oral thrush, hypoalbuminemia, intermittent fevers, diarrhea and feeding intolerance. Rhesus monkey kidney cells inoculated with cerebrospinal fluid revealed reovirus-like particles by electron microscopy. Virus neutralization and RNA-gel electrophoresis studies identified the isolated pathogen as reovirus serotype 2. This report represents one of only a few to isolate reovirus from the central nervous system in humans.
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Affiliation(s)
- Laura Hermann
- Department of Medical Microbiology and Infectious Disease, University of Manitoba, 511-730 William Avenue, Winnipeg, Manitoba R3E 0W3, Canada
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45
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Atkinson HG. What's the difference between bacterial and viral meningitis? Health News 2004; 10:16. [PMID: 15017944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Sporer B, Koedel U, Paul R, Eberle J, Arendt G, Pfister HW. Vascular endothelial growth factor (VEGF) is increased in serum, but not in cerebrospinal fluid in HIV associated CNS diseases. J Neurol Neurosurg Psychiatry 2004; 75:298-300. [PMID: 14742610 PMCID: PMC1738877 DOI: 10.1136/jnnp.2003.016287] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Vascular endothelial growth factor (VEGF) is a potent angiogenic and mitogenic peptide, which also induces several mediators that may play a role in HIV induced CNS damage. VEGF levels were determined in cerebrospinal fluid (CSF) and serum samples from patients with (n = 8) and without (n = 19) directly HIV associated CNS disorders and HIV negative control patients (n = 18). VEGF serum but not CSF levels were significantly increased in HIV infected patients with (381.1 (78.9) pg/ml) HIV associated CNS diseases compared with those without (120.8 (13.1) pg/ml) and HIV negative control patients (133.1(14.8) pg/ml). Serum samples from patients with untreated HIV associated encephalopathy (HIVE, n = 3) contained the highest VEGF levels (583.9 (71.5) pg/ml). In two patients VEGF serum levels were reduced during antiretroviral therapy. However, regardless of effective viral suppression, patients with HIVE still had higher levels compared with HIV infected patients without HIVE. A relevant increase of serum VEGF was not observed in patients without HIVE though high HI viral load. We conclude that HIVE is associated with increased serum VEGF levels. Further studies are warranted to elucidate the role of VEGF in HIVE.
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Affiliation(s)
- B Sporer
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany.
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Dumois J, Jara A, Pomerance HH, Ahmed A, Gilbert-Barness E. Clinico-pathologic conference: a 7-year-old girl with fever and lymphadenopathy. ACTA ACUST UNITED AC 2003; 22:285-301. [PMID: 14692225 DOI: 10.1080/pdp.22.4.285.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Juan Dumois
- Department of Pediatrics, USF College of Medicine, 17 Davis Boulevard, Suite 200, Tampa, FL 33606, USA
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Hosoya R, Murakami K, Takahashi N, Suzuki Y, Tomita T, Fukuchi N, Abo W, Nishijima M. [A case presenting with hydrocephalus and posterior fossa subdural effusion]. No Shinkei Geka 2003; 31:989-93. [PMID: 14513782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
We report a case of hydrocephalus due to posterior cranial fossa subdural effusion. The patient was a 4-year-old boy, presenting headache and nausea, with a medical history of viral meningitis 2 months before. Cerebrospinal fluid provided no evidence of infection, and symptoms caused by increased intracranial pressure gradually deteriorated, although glycerol infusion was effective temporarily. Computed tomography revealed marked ventriculomegaly with subdural effusion in the right posterior cranial fossa. The subarachnoid space in the posterior fossa was very tight, and the cerebellum and brain stem were compressed anteriorly. Magnetic resonance imaging demonstrated stenosis of the aqueduct and foramens of Luschka and Magendie. The cerebeller tonsil was dislocated inferiorly, indicating impending herniation, so an emergency operation was performed. Ventriculoperitoneal shunt was undertaken after implantation of an Ommaya reservoir for the posterior fossa subdural effusion. The patient's postoperative course was uneventful, and the symptoms were improved. Although hydrocephalus and subdural effusion following viral meningitis is rare, neuroimaging studies such as CT and MRI should be examined when a young child suffers from symptoms of increased intracranial pressure.
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Affiliation(s)
- Riki Hosoya
- Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higahshi-tsukurimichi, Aomori-city, Aomori 030-8553, Japan
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Affiliation(s)
- Lia Simpson Erickson
- Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Abstract
A case of West Nile virus (WNV) infection with meningitis and optic neuritis in a 28-year-old man is presented. The patient had a number of unusual clinical and laboratory findings that broadened the differential diagnosis. The emergence of WNV infection in southern Europe and North America calls for increased awareness of physicians to this clinical entity.
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Affiliation(s)
- R Gilad
- Dept of Neurology, Wolfson Medical Center, Holon, Israel
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