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Abstract
BACKGROUND Bacterial meningitis is known to cause hearing impairments and neurologic deficits; however, less is known regarding psychiatric disabilities. In this study, we assessed psychiatric disabilities and other long-term consequences of childhood bacterial meningitis. METHODS From a previously validated dataset, we selected children having had bacterial meningitis. We then reviewed medical records and child health records from discharge onwards to identify disabilities. We calculated the occurrence of disabilities with a 95% confidence interval (CI), and we used a χ test to assess possible individual risk factors associated with occurrence of disabilities. RESULTS Of the 80 children included in this study, permanent disabilities not attributed to preexisting diseases were noted in 56% (CI: 45-67) during the mean observation period of 19 years and 2 months. Psychiatric disease was diagnosed in 30% (CI: 21-41), and another 5% (CI: 2-13) were under ongoing investigations for symptoms of psychiatric disease. Hearing impairments affected at least 30% (CI: 20-40), and neurologic deficits affected at least 23% (CI: 15-34). While other disabilities were often detected within the first year, psychiatric disabilities were detected after a mean time period of 14 years (CI: 11:1-16:11). Although some associations were noted, no individual risk factor was able to predict the occurrence of disabilities. CONCLUSIONS Psychiatric disabilities affect more than one-third of survivors and are among the most common long-term consequence of childhood bacterial meningitis. Late discovery and predictive difficulties call for a revision of current guidelines to include a specific long-term strategy for detecting psychiatric disabilities.
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Affiliation(s)
- Urban Johansson Kostenniemi
- From the Department of Clinical Sciences, Pediatrics
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | | | - Linda Karlsson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
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2
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Trobos M, Johansson ML, Jonhede S, Peters H, Hoffman M, Omar O, Thomsen P, Hultcrantz M. The clinical outcome and microbiological profile of bone-anchored hearing systems (BAHS) with different abutment topographies: a prospective pilot study. Eur Arch Otorhinolaryngol 2018; 275:1395-1408. [PMID: 29623410 PMCID: PMC5951894 DOI: 10.1007/s00405-018-4946-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/20/2018] [Indexed: 02/07/2023]
Abstract
Purpose In this prospective clinical pilot study, abutments with different topologies (machined versus polished) were compared with respect to the clinical outcome and the microbiological profile. Furthermore, three different sampling methods (retrieval of abutment, collection of peri-abutment exudate using paper-points, and a small peri-abutment soft-tissue biopsy) were evaluated for the identification and quantification of colonising bacteria. Methods Twelve patients, seven with machined abutment and five with polished abutment, were included in the analysis. Three different sampling procedures were employed for the identification and quantification of colonising bacteria from baseline up to 12 months, using quantitative culturing. Clinical outcome measures (Holgers score, hygiene, pain, numbness and implant stability) were investigated. Results The clinical parameters, and total viable bacteria per abutment or in tissue biopsies did not differ significantly between the polished and machined abutments. The total CFU/mm2 abutment and CFU/peri-abutment fluid space of anaerobes, aerobes and staphylococci were significantly higher for the polished abutment. Anaerobic bacteria were detected in the tissue biopsies before BAHS implantation. Anaerobes and Staphylococcus spp. were detected in all three compartments after BAHS installation. For most patients (10/12), the same staphylococcal species were found in at least two of the three compartments at the same time-point. The common skin coloniser Staphylococcus epidermidis was identified in all patients but one (11/12), whereas the pathogen Staphylococcus aureus was isolated in five of the patients. Several associations between clinical and microbiological parameters were found. Conclusions There was no difference in the clinical outcome with the use of polished versus machined abutment at 3 and 12 months after implantation. The present pilot trial largely confirmed a suitable study design, sampling and analytical methodology to determine the effects of modified BAHS abutment properties. Level of evidence 2. Controlled prospective comparative study. Electronic supplementary material The online version of this article (10.1007/s00405-018-4946-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden.
| | - Martin Lars Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
- Oticon Medical AB, Askim, Sweden
| | | | | | - Maria Hoffman
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 405 30, Gothenburg, Sweden
| | - Malou Hultcrantz
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
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3
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Abstract
OBJECTIVE: To review the clinical manifestations and the follow-up hearing results of the treatment modalities in the patients with otosyphilis. STUDY DESIGN AND SETTINGS: A retrospective review between 1984 and 2000 at a university hospital. Patients who presented with cochleovestibular symptoms and were confirmed seropositive for specific treponemal tests were included. Excluded were patients older than 70, or who had other identified causes of cochleovestibular symptoms. RESULTS: Subjects included 56 males and 29 females with an average age of 59.5 years (range, 40 to 70). Common presenting symptoms included hearing loss (90.6%), tinnitus (72.9%), and vertigo (52.9%). The cerebrospinal fluid analysis was positive in 5.4%. The overall respective hearing results in the short- and long-term follow-up were improved or stable in 93.4% and 83.3% of patients. Even though adding steroids and neurosyphilis regimens tended to improve and stabilize hearing, the results were not statistically significant among treatment modalities. CONCLUSION: Further study about hearing outcomes among treatment modalities is suggested. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- Kwanchanok Yimtae
- Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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4
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Fuchs JC, Zinnamon FA, Taylor RR, Ivins S, Scambler PJ, Forge A, Tucker AS, Linden JF. Hearing loss in a mouse model of 22q11.2 Deletion Syndrome. PLoS One 2013; 8:e80104. [PMID: 24244619 PMCID: PMC3828191 DOI: 10.1371/journal.pone.0080104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 08/09/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
22q11.2 Deletion Syndrome (22q11DS) arises from an interstitial chromosomal microdeletion encompassing at least 30 genes. This disorder is one of the most significant known cytogenetic risk factors for schizophrenia, and can also cause heart abnormalities, cognitive deficits, hearing difficulties, and a variety of other medical problems. The Df1/+ hemizygous knockout mouse, a model for human 22q11DS, recapitulates many of the deficits observed in the human syndrome including heart defects, impaired memory, and abnormal auditory sensorimotor gating. Here we show that Df1/+ mice, like human 22q11DS patients, have substantial rates of hearing loss arising from chronic middle ear infection. Auditory brainstem response (ABR) measurements revealed significant elevation of click-response thresholds in 48% of Df1/+ mice, often in only one ear. Anatomical and histological analysis of the middle ear demonstrated no gross structural abnormalities, but frequent signs of otitis media (OM, chronic inflammation of the middle ear), including excessive effusion and thickened mucosa. In mice for which both in vivo ABR thresholds and post mortem middle-ear histology were obtained, the severity of signs of OM correlated directly with the level of hearing impairment. These results suggest that abnormal auditory sensorimotor gating previously reported in mouse models of 22q11DS could arise from abnormalities in auditory processing. Furthermore, the findings indicate that Df1/+ mice are an excellent model for increased risk of OM in human 22q11DS patients. Given the frequently monaural nature of OM in Df1/+ mice, these animals could also be a powerful tool for investigating the interplay between genetic and environmental causes of OM.
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Affiliation(s)
- Jennifer C. Fuchs
- Craniofacial Development & Stem Cell Biology, King's College London, London, United Kingdom
| | | | - Ruth R. Taylor
- Ear Institute, University College London, London, United Kingdom
| | - Sarah Ivins
- Institute of Child Health, University College London, London, United Kingdom
| | - Peter J. Scambler
- Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Forge
- Ear Institute, University College London, London, United Kingdom
| | - Abigail S. Tucker
- Craniofacial Development & Stem Cell Biology, King's College London, London, United Kingdom
| | - Jennifer F. Linden
- Ear Institute, University College London, London, United Kingdom
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, United Kingdom
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5
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Neves da Silva CNG, Carneiro de Araujo RS, Araujo Filho JA. Streptococcus bovis meningitis associated with colonic diverticulosis and hearing impairment: a case report. Infez Med 2011; 19:262-265. [PMID: 22212167] [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
A 75-year-old woman presented to the Tropical Diseases Hospital, Goiania, Brazil, with a two-day history of fever and chills followed by headache and vomiting over the last 24 hours. The cerebrospinal fluid (CSF) showed 270 leukocytes/mmc (30 percent neutrophils); 20 red cells/mmc; undetectable levels of glucose and 232 mg/dL of protein. The Gram stain revealed several Gram-positive cocci, and CSF culture yielded Streptococcus bovis. A colonoscopy showed diverticula in descendent and transverse colon. After a 14-day course of penicillin G, the patient was discharged in a good state of health, with only mild hearing impairment.
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6
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Trotman H, Olugbuyi O, Barton M, McGregor D, Thomas S. Pneumococcal meningitis in Jamaican children. W INDIAN MED J 2009; 58:585-588. [PMID: 20583688] [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: 05/29/2023]
Abstract
OBJECTIVE To describe the clinical features and outcome of pneumococcal meningitis in Jamaican children. METHODS All patients admitted to the Bustamante Hospital for Children, during the period 1995-1999, who had pneumococcus isolated from cerebrospinal fluid (CSF) or pleocytosis in association with a blood culture isolate of pneumococcus were selected. Demographic, clinical and laboratory data were collected. RESULTS Twenty-five (23%) of 111 patients with pneumococcal infections satisfied criteria for meningitis. The median age was 8 months (range 0.5-60 months). There were 4 (16%) cases of sickle cell disease, 2 (50%) of whom were first diagnosed during the current illness. This represents a 53-fold increased risk of pneumoccocal meningitis in patients with Sickle-cell disease based on population prevalence rates. Oxacillin resistance occurred in 3 (12%) patients, one of whom died. Mortality rate was 12% (3) with all deaths occurring in infants < 1 year. Poor outcome occurred in 36% (9) of the patients. Of the (35%) 8 survivors who had follow-up evaluation, (38%) 3 had documented hearing loss. CONCLUSIONS Meningitis is a common clinical syndrome of invasive pneumococcal disease, occurring in 23% of cases resulting in mortality and high morbidity among Jamaican children. Local seroepidemiological studies are urgently needed to inform national vaccine decisions. As an interim plan, policymakers should consider a risk-based strategy to vaccine prophylaxis that will ensure that high risk groups such as children with sickle cell disease are offered currently available conjugate pneumococcal vaccines.
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Affiliation(s)
- H Trotman
- Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies, Kingston 7, Jamaica.
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7
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Abstract
Streptococcus suis Meningitis, United States
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Affiliation(s)
- Gregory T. Lee
- University of California San Francisco, San Francisco, California, USA
| | - Charles Y. Chiu
- University of California San Francisco, San Francisco, California, USA
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8
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Karaca S, Demiroglu YZ, Karataş M, Tan M. Acquired progressive spastic paraparesis due to neurobrucellosis: a case report. Acta Neurol Belg 2007; 107:118-121. [PMID: 18416286] [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: 05/26/2023]
Abstract
A 39-year-old man with a 4-month history of transient pins and needles sensations occurring below the waist while walking and difficulty walking presented to our outpatient clinic. He had an approximate 1-year history of bilateral hearing loss, the etiology of which was unknown. His symptoms had been progressive, and there was no significant family history. He demonstrated a spastic gait and required assistance for walking. Deep tendon reflexes were hypertonic; a sensation deficit was defined as originating from the 12th thoracic vertebra. Babinski's sign was positive bilaterally. Sphincter abnormalities were seen in the patient's bladder and bowel functions. Cerebral and spinal magnetic resonance images with contrast media were unremarkable. An analysis of the patient's cerebrospinal fluid was consistent with neurobrucellosis. Owing to spastic paraparesis and hearing loss, the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started and continued 6 months. His neurologic condition improved, and he was able to walk without help after 3 months' treatment. Our case illustrates that acquired progressive spastic paraparesis may occur during the course of neurobrucellosis. Neurobrucellosis should be borne in mind when patients present with spastic paraparesis.
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Affiliation(s)
- Sibel Karaca
- Department of Neurology, Faculty of Medicine, Baskent University, Medical School, Ankara, Turkey.
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9
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Franco-Vidal V, Beurg M, Darrouzet V, Bébéar JP, Skinner LJ, Dulon D. Zinc protection against pneumolysin toxicity on rat cochlear hair cells. Audiol Neurootol 2007; 13:65-70. [PMID: 17890859 DOI: 10.1159/000108763] [Citation(s) in RCA: 12] [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] [Received: 03/21/2007] [Accepted: 07/04/2007] [Indexed: 11/19/2022] Open
Abstract
Streptococcus pneumoniae can induce local and systemic diseases such as meningitis, otitis media, and pneumonia. One third of these meningitis cases can be associated with irreversible sensorineural hearing loss whose mechanisms likely involves the exotoxin pneumolysin (PLY) that irreversibly damages cochlear hair cells (HCs). In the respiratory system and in neuron it has been demonstrated that zinc deficiency increases severity and mortality of such infections in animal models and in children. Moreover, zinc supplementation can decrease the severity of pneumococcal respiratory infections. The aim of our study was to assess the potential protective effect of zinc against PLY toxicity on HCs in culture. Our results showed that in the presence of zinc at concentration as low as 1 microM, the toxicity of PLY was largely reduced by about 50% for both inner and outer HCs. At 300 microM of zinc, protection significantly increased with 62 and 55.2% for IHCs and OHCs, respectively. Our results suggest that the protective effect of zinc is likely due to an inhibition of the toxin incorporation and aggregation into the plasma membrane, thus preventing calcium influx through the toxin pores. Our findings raise the possibility that treatments with zinc may help to prevent debilitating otological sequelae from pneumococcal infection.
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Affiliation(s)
- Valérie Franco-Vidal
- Otolaryngology and Skull Base Surgery Department, University of Bordeaux 2 Victor Segalen, Bordeaux, France.
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10
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Mahajan SK, Bakshi D. Acute reversible hearing loss in scrub typhus. J Assoc Physicians India 2007; 55:512-4. [PMID: 17907503] [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: 05/17/2023]
Abstract
Scrub typhus usually presents as pyrexia with or without multiple organ involvement. Acute hearing loss occurs in about one third of cases and is a useful clue toward the diagnosis. We present two cases of scrub typhus with acute reversible hearing loss from an endemic area. The diagnosis was confirmed by nested PCR.
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Affiliation(s)
- S K Mahajan
- Deen Dayal Upadhayaya Zonal Hospital, Shimla, Himachal Pradesh, India
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11
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Ono T, Yoshida Y, Izumaru S, Nakashima T. A case of nasopharyngeal actinomycosis leading to otitis media with effusion. Auris Nasus Larynx 2006; 33:451-4. [PMID: 16949780 DOI: 10.1016/j.anl.2006.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 09/09/2005] [Revised: 03/24/2006] [Accepted: 05/26/2006] [Indexed: 11/23/2022]
Abstract
Nasopharyngeal actinomycosis is extremely rare, and to our knowledge, only seven cases have previously been reported. Diagnosis of actinomycosis is made by clinical finding, observation of the bacteria and histopathological examination. Treatment for actinomycosis is surgical debridement and administration of antibioticus, especially penicillin for several weeks with good prognosis. We report a case of nasopharyngeal actinomycosis, which lead to otitis media with effusion. Endoscopic surgery and prolonged penicillin administration for 2 months were effective for treatment of actinomycosis in the nasopharynx.
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Affiliation(s)
- Takeharu Ono
- Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Kurume University, Asahimachi 67, Kurume, Japan.
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12
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Matos JO, Arruda AM, Tomita S, Araujo PDPM, Madeira FB, Sarmento Junior KMDA. Cryptococcus Meningitis and reversible hearing loss. Braz J Otorhinolaryngol 2006; 72:849. [PMID: 17308841 PMCID: PMC9442089 DOI: 10.1016/s1808-8694(15)31055-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 06/14/2006] [Indexed: 11/29/2022] Open
Affiliation(s)
- Janini Oliveira Matos
- Serviço de Otorrinolaringologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro.
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13
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See H, Aubertin G, Angoulvant F, Baculard F, Soussan V, Bourrillon A, Faye A. [Chronic otitis and hearing loss revealing a disseminated tuberculosis in a child]. Arch Pediatr 2006; 13:1233-5. [PMID: 16829062 DOI: 10.1016/j.arcped.2006.05.014] [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: 06/13/2005] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
UNLABELLED Ear localization is sometimes the first symptom of tuberculosis. CASE REPORT We report a case of a teen with a chronic otitis revealing a disseminated tuberculosis. The investigations showed ear, bones and pulmonary localisations. The outcome with treatment showed a persistent hearing loss. CONCLUSION Middle ear tuberculosis should be suspected in patients with chronic otitis and risk factors of tuberculosis. A disseminated tuberculosis should be investigated and an early treatment is necessary to prevent hearing loss.
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Affiliation(s)
- H See
- Pédiatrie générale, Assistance publique-Hôpitaux de Paris, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
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14
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Premaratna R, Chandrasena TGAN, Dassayake AS, Loftis AD, Dasch GA, de Silva HJ. Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease. Clin Infect Dis 2005; 42:e6-8. [PMID: 16323083 DOI: 10.1086/498747] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [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: 07/19/2005] [Accepted: 09/03/2005] [Indexed: 11/03/2022] Open
Abstract
We describe 6 patients with scrub typhus who presented with acute hearing loss, a forgotten complication of this reemerging disease. They were admitted with fever of 10-14 days' duration and had clinical evidence of deafness and pneumonitis. Five patients had eschars, which prompted the diagnosis of typhus fever and led to early institution of treatment. Deafness has been described as a clue to the diagnosis of scrub typhus; awareness of this symptom facilitated early diagnosis in 4 of 5 patients who recovered. Acute hearing loss or hearing impairment in a febrile patient should arouse strong suspicion of scrub typhus.
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Affiliation(s)
- R Premaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka.
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15
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16
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Abstract
Bacterial meningitis is still one of the most common causes of acquired profound sensorineural deafness in children despite antibiotic treatment. We investigated the neuroprotective effects of brain-derived neurotrophic factor on hearing function in experimental bacterial meningitis. We implanted stainless steel tubes into both cerebral ventricles of Sprague-Dawley rats aged 21 days. Bacterial meningitis was induced by inoculating a strain of serotype III Streptococcus pneumoniae into the cisterna magna. Six micrograms per day of brain-derived neurotrophic factor (groups 1 and 3) or albumin (groups 2 and 4) was injected into the cerebral ventricles 24 hours after or before infection, respectively, for a duration of 7 days. Additionally, all rats received antibiotic subcutaneous treatment starting 24 hours after infection for 7 days. Brainstem auditory evoked potentials were recorded 24 hours before and 24 hours after infection and after 7 days of treatment with brain-derived neurotrophic factor or placebo and antibiotics, respectively, to determine hearing threshold. Our results showed that the hearing thresholds of animals in each group increased significantly 24 hours after infection compared with the results recorded 24 hours before infection (P < .01). After 7 days of treatment with brain-derived neurotrophic factor, brainstem auditory evoked potential responses recurred in 16 ears when stimulated at 75 dB hearing level in groups 1 and 3. Their hearing thresholds significantly decreased compared with the control group 2 (P < .05) and group 4 (P < .01). However, 13 of 14 ears absent brainstem auditory evoked potential responses could still not be identified at 75 dB hearing level in control groups 2 and 4. The improvement of the hearing thresholds in group 3 (treated before infection) was greater than that of group 1 (treated after infection) (P < .05), but there was no significant difference found between the control groups before and after infection (P > .05). Our study supports the hypothesis that the administration of exogenous brain-derived neurotrophic factor can be effective in preventing or treating hearing loss following bacterial meningitis.
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Affiliation(s)
- Ling Li
- Department of Pediatric Neurology, the First People's Hospital of Yunnan Province, Kunming, Affiliated Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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17
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Iero I, Elia M, Cosentino FII, Lanuzza B, Spada RS, Toscano G, Tripodi M, Belfiore A, Ferri R. Isolated monolateral neurosensory hearing loss as a rare sign of neuroborreliosis. Neurol Sci 2004; 25:30-3. [PMID: 15060815 DOI: 10.1007/s10072-004-0224-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 06/06/2003] [Accepted: 01/26/2004] [Indexed: 11/26/2022]
Abstract
Lyme disease, or borreliosis, is a zoonosis transmitted by Borrelia burgdorferi which also involves the central nervous system (CNS), in 15% of affected individuals, with the occurrence of aseptic meningitis, fluctuating meningoencephalitis, or neuropathy of cranial and peripheral nerves. Encephalopathy with white matter lesions revealed by magnetic resonance imaging (MRI) scans in late, persistent stages of Lyme disease has been described. In this report, we describe a patient with few clinical manifestations involving exclusively the eighth cranial nerve, monolaterally and diffuse bilateral alterations of the white matter, particularly in the subcortical periventricular regions at cerebral MRI. This single patient study shows that the search for antibodies against Borrelia burgdoferi should always be performed when we face a leukoencephalopathy of unknown origin. An isolated lesion of the eighth cranial nerve can be the only neurologic sign in patients with leukoencephalopathy complicating Lyme disease.
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Affiliation(s)
- I Iero
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging, Via Conte Ruggero 73, I-94018 Troina (EN), Italy.
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18
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Abstract
Studies on the incidence and spectrum of complications and prognostic factors in adults with pneumococcal meningitis are scarce. Therefore, we analysed 87 consecutive cases who were treated in our department between 1984 and 2002. Meningitis-associated intracranial complications developed in 74.7% and systemic complications in 37.9% of cases. Diffuse brain oedema (28.7%) and hydrocephalus (16.1%) developed more frequently than previously reported. The incidences of arterial (21.8%) and venous (9.2%) cerebrovascular complications were also very high. Furthermore, 9.2% of cases developed spontaneous intracranial haemorrhages (two patients with subarachnoid and two with subarachnoid and intracerebral bleedings, all in association with vasculitis; one subject with intracerebral haemorrhage due to sinus thrombosis; and three cases with intracerebral bleedings of unknown aetiology). Other new findings were the incidence of acute spinal cord dysfunction due to myelitis (2.3%) and that of hearing loss (19.5% of all patients and 25.8% of survivors). The in-hospital mortality was 24.1%. Only 48.3% of the patients had a good outcome at discharge [Glasgow Outcome Scale Score (GOS) = 5]. Outcome did not change during the study period, as mortality and GOS were similar for patients treated between 1984 and 1992 and for those treated between 1993 and 2002. Factors associated with a bad outcome (GOS </= 4) were chronic debilitating diseases, low Glasgow Coma Scale Score and focal neurological deficits on admission, low CSF leucocyte counts, pneumonia, bacteraemia and meningitis-associated intracranial and systemic complications. Low CSF leucocyte counts were also associated with the development of meningitis-associated intracranial complications. Age > or =60 years was associated with a higher mortality (36.7 versus 17.5%), but the GOS of the survivors was comparable to that of the surviving younger patients. The causes of death were mostly systemic complications in the elderly and cerebral complications in the younger patients. A haematogenous pathogenesis seemed likely in asplenic patients, while contiguous spread from sinusitis or otitis was the major cause of meningitis in non-asplenic individuals. Furthermore, asplenic patients had a raised incidence of meningitis-associated intracranial complications, but their outcome was similar to that of non-asplenic subjects. The morbidity and mortality of pneumococcal meningitis in adults are still devastating. We report higher incidences (diffuse brain swelling, hydrocephalus, cerebrovascular complications) or new incidences (myelitis, hearing loss, subarachnoid bleeding) of intracranial complications. Our detailed analysis of prognostic factors may help clinicians to identify patients at risk and may also be helpful in the design of clinical trials.
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Affiliation(s)
- Stefan Kastenbauer
- Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
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19
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Panek B, Chyczewska E. [Tuberculosis of ear and cutis]. Pneumonol Alergol Pol 2002; 69:669-72. [PMID: 12134444] [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: 02/25/2023] Open
Abstract
We describe a 26 year old woman treated for near a year because of deafness, purulent otitis, cough and purulent skin lesions. She was treated by otolaryngologist. Sputum examination for acid fast bacilli and chest x-ray were not done a that time. In hospital chest x-ray revealed a cava in left lung and tuberculous bacilli were found in sputum and in content from ear. Tuberculin test was positive. Tuberculosis of lung, skin and cor was recognized. After 4 months of initial treatment patient was referred to outpatient department for further therapy.
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Affiliation(s)
- B Panek
- Kliniki Chorób Płuc i Gruźlicy Akademii Medycznej w Białymstoku
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Daoud AS, al-Sheyyab M, Batchoun RG, Rawashdeh MO, Nussair MM, Pugh RN. Bacterial meningitis: still a cause of high mortality and severe neurological morbidity in childhood. J Trop Pediatr 1995; 41:308-10. [PMID: 8531266 DOI: 10.1093/tropej/41.5.308] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [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: 01/31/2023]
Abstract
Among 121 cases of bacterial meningitis (age 2 months to 12 years; mean, 35 months) treated over a 3-year period, Neisseria meningitidis was the most common pathogen (33 per cent), then Haemophilus influenzae (32 per cent) and Streptococcus pneumoniae (15 per cent). In the H. influenzae group, 95 per cent were aged below 2 years. Overall mortality was 12 per cent: higher in the S. pneumoniae (17 per cent) and less common organism (21 per cent) groups. Neurological sequelae in 21 (20 per cent) of the 106 survivors included hearing impairment in 17 and quadriparesis in eight. Meningitis caused by S. pneumoniae contained a significantly higher proportion of children with neurological morbidity (P = 0.0128). The addition of dexamethasone treatment during the third year produced an apparent but not significant trend towards less mortality (P = 0.7568), fewer neurological sequelae (P = 0.3401) and less hearing impairment (P = 0.3903). Despite the availability of effective chemotherapy, bacterial meningitis will remain an important cause of high mortality and considerable morbidity.
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Affiliation(s)
- A S Daoud
- Department of Paediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
A 36-year-old man was admitted to our university hospital, complaining of acute hearing loss of the right ear, which was his only hearing ear. He had developed complete deafness due to mumps in the left ear at the age of 26. Before admission, he had been diagnosed as having rubella infection. He noticed hearing loss in the right ear two days after disappearance of macular rash. Headache, nausea and vertigo were not present. Three weeks after the onset of hearing loss, he was admitted to our university hospital. Pure tone audiometry revealed sensorineural hearing loss; a mild ascending audiometric curve with a marked loss at 4,000 Hz and 8,000 Hz. SISI test was positive. Caloric stimulation (ice water 10 ml/10 s) to the right ear demonstrated a normal response. Rubella hemagglutination antibody titer was 512. Specific IgG antibody was over 3,200. Specific IgM antibody was positive (7.01 Enzyme Immunoassay). The data indicated recent infection with rubella. He was given betamethasone for 14 days. Pure tone audiometry showed hearing improvement.
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Affiliation(s)
- H Kobayashi
- Department of Otolaryngology, Showa University, Tokyo, Japan
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Ormay I, Kovács P. [Lymphocytic choriomeningitis causing unilateral deafness]. Orv Hetil 1989; 130:789-91. [PMID: 2710545] [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: 01/02/2023]
Abstract
Lymphocytic choriomeningitis is generally a benign disease passing off without complication. The authors describe a case where the disease appeared in the form of febrile infection and caused permanent unilateral deafness. In connection with this case the authors review briefly the clinical aspects, diagnostic difficulties of lymphocytic choriomeningitis virus infection and wish to draw the attention to the possibility of a lymphocytic choriomeningitis infection in the background of parainfluenza diseases occurring mainly in cold months.
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Abstract
A 26-year-old woman with bilateral otosclerosis underwent right stapedectomy with an excellent result. One year later, however, she developed symptoms of mumps and within two days was completely deaf in the right ear. Prompt surgical exploration excluded a complication of the otosclerosis and a perilymph fistula, but culture of a sample of perilymph grew mumps virus. The case provides direct evidence of a relation between mumps virus infection and inner-ear damage.
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