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meningitis prevention and treatment

Royce Johnson, Jackie Ho, Pete Fowler, Arash Heidari
PURPOSE OF REVIEW: This article summarizes the diagnosis and treatment of coccidioidal meningitis (CM) and its complications. An overview of current and prospective pharmacologic treatment options and monitoring parameters is provided. A consensus has not been reached regarding universally accepted therapeutic serum levels for azoles because of insufficient evidence. We describe the preferred therapeutic drug level ranges that our institution uses to monitor azole therapy. RECENT FINDINGS: Ho et al...
March 13, 2018: Current Neurology and Neuroscience Reports
Seungyeop Lee, Si-On Lee, Gyu-Lee Kim, Dong-Kwon Rhee
AIMS: Streptococcus pneumoniae infection in acute bacterial meningitis can lead to widespread brain damage and mortality. Inflammatory responses by immune cells in the brain are thought to determine the degree of brain injury. Yet, the mechanisms underlying host responses to pneumococcal meningitis are largely unknown. To explore host responses as a potential therapeutic target for preventing brain injury after pneumococcal meningitis. METHODS: We evaluated signaling mechanisms that minimize neuronal damage caused by pneumococcal infection; specifically, we assessed pathways related to neuronal survival after enhancing estrogen receptor-β (ER-β) expression using a natural therapeutic substance known as ginsenoside Rb1 and Rg3 enhanced ginseng...
March 9, 2018: CNS Neuroscience & Therapeutics
Ahmad Mourad, John R Perfect
Cryptococcal meningitis is the most common central nervous system infection in the world today. It occurs primarily, but not exclusively, in immunocompromised individuals and despite substantial improvement in management of clinical events like AIDS, the numbers of cases of cryptococcosis remain very high. Unfortunately, despite several antifungal agents available for treatment, morbidity and mortality rates remain high with this fungal infection. In this Review, we will describe the treatments and strategies for success, identify the failures, and provide insights into the future developments / improvements for management...
2018: Memórias do Instituto Oswaldo Cruz
Taty Tshimangani, Jean Pongo, Joseph Bodi Mabiala, Marcel Yotebieng, Nicole F O'Brien
Empirical knowledge suggests that acute neurologic disorders are common in sub-Saharan Africa, but studies examining the true burden of these diseases in children are scarce. We performed this prospective, observational study to evaluate the prevalence, clinical characteristics, treatment approaches, and outcomes of children suffering acute neurologic illness or injury (ANI) in an urban and rural site in the Democratic Republic of the Congo. Over 12 months, 471 out of 6,563 children admitted met diagnostic criteria for ANI, giving a hospital-based prevalence of 72/1,000 admissions...
March 5, 2018: American Journal of Tropical Medicine and Hygiene
Nguyen Th Mai, Nicholas Dobbs, Nguyen Hoan Phu, Romain A Colas, Le Tp Thao, Nguyen Tt Thuong, Ho Dt Nghia, Nguyen Hh Hanh, Nguyen T Hang, A Dorothee Heemskerk, Jeremy N Day, Lucy Ly, Do DA Thu, Laura Merson, Evelyne Kestelyn, Marcel Wolbers, Ronald Geskus, David Summers, Nguyen Vv Chau, Jesmond Dalli, Guy E Thwaites
Background Adjunctive dexamethasone reduces mortality from tuberculous meningitis (TBM) but not disability, which is associated with brain infarction. We hypothesised that aspirin prevents TBM-related brain infarction through its anti-thrombotic, anti-inflammatory, and pro-resolution properties. Methods We conducted a randomised controlled trial in HIV-uninfected adults with TBM of daily aspirin 81mg or 1000mg, or placebo, added to the first 60 days of anti-tuberculosis drugs and dexamethasone (NCT02237365)...
February 27, 2018: ELife
Ahmed H Qavi, Tasnim F Imran, Zachariah Hasan, Fariha Ilyas
Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypical symptoms. We describe the case of a 31-year-old man with a history of diabetes who presented with a sub-acute onset of right-sided facial weakness and right gaze difficulty with diplopia. History revealed low-grade fever, right-sided headache, fatigue and moderate weight loss for the past several weeks. The patient did not report neck stiffness, rigidity, fever, chills or cough...
December 7, 2017: Curēus
Yuichi Ito, Yoshio Araki, Takashi Izumi, Sho Okamoto, Masaaki Kimura, Toshihiko Wakabayashi
BACKGROUND: Oncotic aneurysm is a rare condition with a high mortality rate. Since no consensus has been reached regarding therapeutic strategy for ruptured oncotic aneurysm, treatment remains challenging. CASE DESCRIPTION: A 35-year-old woman developed sudden onset of severe headache. Computed tomography showed subarachnoid hemorrhage and cerebral angiography revealed two fusiform aneurysms in the distal portion of the left middle cerebral artery. Aneurysmectomy with vessel reconstruction using a superficial temporal artery graft was performed to maintain blood flow to the distal middle cerebral artery...
February 15, 2018: World Neurosurgery
Jiliang Zhai, Ripul R Panchal, Ye Tian, Shujie Wang, Lijuan Zhao
Cerebrospinal fluid (CSF) leak is a rare but potentially troublesome and occasionally catastrophic complication after anterior cervical decompression surgery. There is limited literature describing this complication, and the management of CSF leak varies. The aim of this study was to retrospectively review the treatment of cases with CSF leak and develop a management algorithm. A series of 14 patients with CSF leak from January 2011 to May 2016 were included in this study. Their characteristics, management of CSF leak, and outcomes were documented...
February 16, 2018: Orthopedics
Tsuguto Fujimoto
Enterovirus A71 (EV-A71), coxsackievirus A16 (CV-A16), and CV-A6 are the major causative agents of Hand-foot-and-mouth disease (HFMD). These viruses belong to the species Enterovirus A of the genus Enterovirus of the family Picornaviridae. These viruses can also cause aseptic meningitis (AM), encephalitis and/or paralysis. EV-A71 is one of the main infectious agents related to severe encephalitis. Between 1997 and 2013, East and Southeast Asia experienced large encephalitis outbreaks caused by EV-A71 infections, which ranged from severe to lethal...
February 2018: Brain and Nerve, Shinkei Kenkyū No Shinpo
Meghan Wilson, Carl Snyderman
Developmental anomalies of the skull base may present in childhood or as an adult. The most common pathologies include dermoid, encephalocele, and glioma. Encephaloceles may present as part of a syndrome. Other entities include infantile hemangiomas and teratoma. Endoscopic techniques provide a less invasive and morbid option for treatment. Proper evaluation and treatment is necessary to prevent complications such as meningitis.
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Arnaud Dominati, Liesbeth Sap, Samir Vora
Arbovirus infections are emerging pathogens leading sometimes to severe disease. This virus is transmitted by sandflies in the Mediterranean countries during the summer season. The disease is often asymptomatic but can also cause an influenza-like illness and aseptic meningitis or encephalitis. The treatment is supportive and preventive measures should be taken in order to avoid an infection when travelling to the affected areas. The differential diagnosis of fever in the returning traveler from southern European countries should include Toscana virus...
January 31, 2018: Revue Médicale Suisse
Reza Taherkhani, Fatemeh Farshadpour, Mohammad Reza Ravanbod
We report a case of vaccine-associated paralytic poliomyelitis (VAPP) in an immunocompromised patient with acute lymphocytic leukemia who was initially diagnosed with aseptic meningitis. Isolation of Sabin-like type 1 poliovirus from the patient's cerebrospinal fluid made this a case of vaccine-related poliovirus (VRPV) infection. The patient developed paralysis and respiratory distress and deceased a few months after onset of paralysis with respiratory failure. This tragic case report highlights the emergence of VAPP and indicates the importance of timely diagnosis of VRPV infections to improve clinical management of VRPV-infected patients and to prevent the devastating consequences of silent introduction of VRPVs in treatment wards and eventually in the society...
January 10, 2018: Journal of Neurovirology
Monica Manglani, Dorian B McGavern
The central nervous system (CNS) is an immunologically specialized organ where restrictive barrier structures protect the parenchyma from inflammation and infection. This protection is important in preventing damage to non-renewable resident cell populations, such as neurons, responsible for functions ranging from executive to autonomic. Despite these barriers, the CNS can be infected through several entry portals, giving rise to meningitis and encephalitis. Following infection, resident cells recruit peripherally derived immune cells to sites of viral infection...
December 29, 2017: Current Opinion in Virology
Nicolas K Khattar, Andrew C White, Enzo M Fortuny, Rob T Hruska, Robert F James
Traumatic pseudoaneurysms of the middle meningeal artery (MMA) represent less than 1% of all intracranial aneurysms, and occur mostly in association with temporal bone fractures following head trauma. Given the unknown natural history, it is unclear whether they should be treated. We present two cases of MMA pseudoaneurysms discovered during trauma workups. The first patient is a 44-year-old male with severe traumatic brain injury (TBI) following a motor vehicle accident. The patient was found to have two right-sided middle meningeal artery pseudoaneurysms that were treated successfully with Onyx® (Medtronic, Minneapolis, MN) embolization...
October 23, 2017: Curēus
Eric J Dziuban, Jessica Franks, Marvin So, Georgina Peacock, David D Blaney
Elizabethkingia species often exhibit extensive antibiotic resistance and result in high morbidity and mortality, yet no systematic reviews exist that thoroughly characterize and quantify concerns for infected infants and children. We performed a review of literature and identified an initial 902 articles; 96 articles reporting 283 pediatric cases met our inclusion criteria and were subsequently reviewed. Case reports spanned 28 countries and ranged from 1944 to 2017. Neonatal meningitis remains the most common presentation of this organism in children, along with a range of other clinical manifestations...
December 2, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Rodrigo Siqueira Batista, Andréia Patrícia Gomes, Jorge Luiz Dutra Gazineo, Paulo Sérgio Balbino Miguel, Luiz Alberto Santana, Lisa Oliveira, Mauro Geller
Meningococcal disease is the acute infection caused by Neisseria meningitidis, which has humans as the only natural host. The disease is widespread around the globe and is known for its epidemical potential and high rates of lethality and morbidity. The highest number of cases of the disease is registered in the semi-arid regions of sub-Saharan Africa. In Brazil, it is endemic with occasional outbreaks, epidemics and sporadic cases occurring throughout the year, especially in the winter. The major epidemics of the disease occurred in Brazil in the 70's caused by serogroups A and C...
November 2017: Asian Pacific Journal of Tropical Medicine
Lutiana R Simões, Roberta R E S Abreu, Jaqueline S Generoso, Jéssica A Goularte, Allan Collodel, Vijayasree Vayalanellore Giridharan, Anitha Christy Sigamani Arumanayagam, Samira S Valvassori, João Quevedo, Tatiana Barichello
The aim of this study was to investigate the effects of lithium on brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and glial cell line-derived neurotrophic factor (GDNF) expression in the hippocampus and on memory in experimental pneumococcal meningitis. The mood-stabilizer lithium is known as a neuroprotective agent with many effects on the brain. In this study, animals received either artificial cerebrospinal fluid or Streptococcus pneumoniae suspension at a concentration of 5 × 109 CFU/mL...
2017: Mediators of Inflammation
Antonio DI Mauro, Francesca Cortese, Nicola Laforgia, Beatrice Pantaleo, Rachele Giuliani, Donato Bonifazi, Marco M Ciccone, Paola Giordano
BACKGROUND: Despite advances in neonatal intensive care and the improvements in surveillance, prevention and vaccination programs, neonatal meningitis still represents an important cause of morbidity and mortality in infants, with the highest mortality in the newborn population. AIM: To summarize current knowledge about this topic with particular attention to management of neonatal meningitis in order to provide a useful tool for clinicians. METHODS: We reviewed the existent literature from five European Countries (France, German, Italy, Spain and United Kingdom) on the effectiveness of treatments for bacterial meningitis in newborns taking into consideration the antibiotic resistance phenomenon...
November 21, 2017: Minerva Pediatrica
Thomas Cars, Irene Eriksson, Anna Granath, Björn Wettermark, Jenny Hellman, Christer Norman, Anders Ternhag
OBJECTIVES: To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs). DESIGN: Ecological time-trend analysis and a prospective cohort study. SETTING: Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016...
November 15, 2017: BMJ Open
Cheryl Hemingway, Maurice Berk, Suzanne T Anderson, Victoria J Wright, Shea Hamilton, Hariklia Eleftherohorinou, Myrsini Kaforou, Greg M Goldgof, Katy Hickman, Beate Kampmann, Johan Schoeman, Brian Eley, David Beatty, Sandra Pienaar, Mark P Nicol, Michael J Griffiths, Simon J Waddell, Sandra M Newton, Lachlan J Coin, David A Relman, Giovanni Montana, Michael Levin
The WHO estimates around a million children contract tuberculosis (TB) annually with over 80 000 deaths from dissemination of infection outside of the lungs. The insidious onset and association with skin test anergy suggests failure of the immune system to both recognise and respond to infection. To understand the immune mechanisms, we studied genome-wide whole blood RNA expression in children with TB meningitis (TBM). Findings were validated in a second cohort of children with TBM and pulmonary TB (PTB), and functional T-cell responses studied in a third cohort of children with TBM, other extrapulmonary TB (EPTB) and PTB...
2017: PloS One
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