DOCSLIB.ORG

Infections of the Nervous System: an Update on Recent Developments

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Infections of the Nervous System: an Update on Recent Developments SEMINAR PAPER R Kay Infections of the nervous system: an A Wu update on recent developments ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ !"#$%&'()"*& The past decade has seen major changes in the field of infectious diseases. In particular, many new infections of the nervous system have been recognised, including the lethal infections of Enterovirus 71, and the Nipah and West Nile viruses. Increased interest in prion diseases has occurred, following the recognition of animal-to-human transmission in Europe. Familiar bacteria such as the pneumococcus continue to cause problems due to increasing resistance to multiple antibiotics. Furthermore, human immunodeficiency virus–infected and other immunocompromised patients are under the constant threat of opportunistic infections, many of which are targeted towards the brain and spinal cord. This paper reviews the changing world of nervous system infection, highlighting some of the most significant recent developments. !"#$%&'()*+,-./01234567 89:;< !"#$%&'()*71 !"# $%&'()*+,-. !"#$%&'()*+,-'./0123456*789:; !"#$%& '()*+,-./0123#415'6789 !"#$%&'()*+,-./01)2'(3456789: !"#$%&'()*+,- #./0123456789:; !"#$%&'()*+,-./0123-4&5678 Key words: Introduction Central nervous system infections/ diagnosis; To many physicians, the possibility of encountering a nervous system Central nervous system infections/ infection is always a source of anxiety. Not only are the physical signs treatment; of such infections often non-specific, but also the consequences of over- Opportunistic infections/ looking a treatable condition can be devastating. Moreover, the means epidemiology of making a rapid diagnosis may be limited. The recognition in the past 2 decades of a number of new infectious agents, some of which are potentially lethal, adds further uncertainty to this difficult area of medicine. ! !"#$%&'() The purpose of this paper is to highlight some of these newer nervous !"#$%&'() system infections which are of regional or global interest. Recent devel- !"#$%&'! opments in the management of older infections and opportunistic infec- tions affecting human immunodeficiency virus (HIV)–infected individuals HKMJ 2001;7:67-72 are also addressed. Department of Medicine and Therapeutics, Bacterial infections The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Pyogenic meningitis R Kay, MD, FRCP Pyogenic meningitis continues to be an important disease worldwide. A Wu, MB, ChB, MRCP (UK) Despite the availability of modern medical care, acute bacterial meningi- Correspondence to: Prof R Kay tis still carries a mortality rate for adults of 25%, which is similar to HKMJ Vol 7 No 1 March 2001 67 Kay et al the experience of the pre-antibiotic era.1 Historically, averted by the early introduction of corticosteroids.6 the three most important pathogens are Streptococcus Of more topical interest, is the concurrent 1998 out- pneumoniae, Neisseria meningitidis, and Haemophilus break of meningitis in previously healthy adults, caused influenzae. In North America and Europe, owing partly by the group B streptococcus, in Singapore and Hong to immunisation practices, the incidence of meningitis Kong. This pathogen normally only causes meningitis caused by H influenzae has declined but S pneumoniae in neonates.7 Unlike S suis meningitis, no particular and N meningitidis remain important pathogens in chil- risk factor was noted for this streptococcal meningitis; dren and young adults. In newborns, group B strepto- nor was it confined to women, whom group B strepto- coccus is the most common pathogen associated with cocci normally inhabit. It remains to be seen whether meningitis. Listeria monocytogenes, transmitted by this neonatal pathogen will emerge as a significant contamination of processed food, is also recognised cause of meningitis in Asia or elsewhere. as a significant cause of meningitis in newborns and the elderly in the United States.2 Tuberculous meningitis Tuberculous meningitis (TBM) is common in the Asian Of particular interest to Southeast Asian physicians region. The annual incidence of TBM in Hong Kong 8 is the fact that the common bacteria causing meningitis is estimated at 1.8 per 100 000 population. Although in this region are somewhat different from those reported classically described as an indolent disease, with a in the West. There are relatively few reports of mening- prodromal illness of malaise, headache, and fever itis caused by N meningitidis and H influenzae in this for 2 to 3 weeks, it is important to realise that TBM region and infections caused by L monocytogenes are can present acutely with disease progression occur- also uncommon. In contrast, Gram negative bacilli such ring within a few days. The diagnosis of TBM is not as Klebsiella pneumoniae and Pseudomonas aeruginosa always straight-forward. Although imaging or cerebro- are increasingly recognised as important pathogens, spinal fluid (CSF) findings are helpful, definitive both in the context of community-acquired meningitis diagnosis can only be made if Mycobacterium tuber- and nosocomial meningitis. This is particularly the case culosis is found in the CSF. Unfortunately, acid-fast stain- among the elderly and individuals with chronic debilitat- ing of the CSF is only 5% to 30% sensitive, and culture ing diseases such as diabetes, cirrhosis, and malignancy. has a sensitivity of only 20% to 50%.9 Since isolation of M tuberculosis usually requires several weeks, various Antibiotic-resistant strains of S pneumoniae, which tests have been developed for rapid diagnosis of TBM. remains the most important pathogen in community- At present, the most promising is the polymerase chain acquired meningitis, are also increasingly recognised. reaction (PCR) assay for DNA fragments of the myco- For nosocomial meningitis (mainly related to head in- bacterium in the CSF, with a sensitivity close to or better jury or neurosurgery), antibiotic-resistant strains of than culture (50% to 85%).10 In this era of increasing Staphylococcus aureus and Acinetobactor baumanii drug resistance, however, culture and sensitivity testing are causing problems for management.3 Empirical remains the cornerstone of management. treatment of community-acquired meningitis should include a third generation cephalosporin plus peni- Lyme disease cillin or ampicillin. For suspected penicillin-resistant Lyme disease, like syphilis, is a multisystem disease S pneumoniae, however, vancomycin should be used with variable neurological manifestations. It is caused in place of penicillin. In the treatment of neurosurgi- by a spirochaete, Borrelia burgdorferi, and transmitted cal or immunocompromised patients, vancomycin plus by ticks. In the United States, Lyme disease is of great ceftazidime are the recommended agents.4 interest, as it accounts for over 90% of vector-borne infections. Although the disease is more prevalent in Uniquely in Hong Kong, two species of strepto- North America and Europe, it has also been seen in cocci other than S pneumoniae have been identified as Japan and northeast China, and should be considered causes of community-acquired meningitis in adults. for patients returning from endemic areas with un- Meningitis caused by Streptococcus suis, once reported explained neurological syndromes. Diagnosis is often as the commonest cause of meningitis in Hong Kong, difficult as the CSF may be normal or show non-specific classically affects patients with occupational exposure findings, and antibody tests vary in sensitivity and to pigs or pork and causes early sensorineural hearing specificity. A prolonged course of antibiotic therapy loss.5 The incidence of this disease has declined in re- (such as ceftriaxone 2 g/d for 2 to 6 weeks) is required cent years and now only isolated cases are seen. None- for treatment. The prognosis is generally good and mor- theless, a high index of suspicion for this condition tality rare, although some late neurological sequelae should be maintained since the hearing loss may be may persist.11 68 HKMJ Vol 7 No 1 March 2001 Infections of the nervous system Whipple’s disease spread to abattoir workers in Singapore. Nipah virus Whipple’s disease is a much rarer systemic disorder is a novel paramyxovirus similar to, but distinct from, which also has a variety of central nervous system the Hendra virus which has caused several deaths (CNS) manifestations, including dementia, ophthal- among Australian racehorse workers. moplegia, and myoclonus. It can also present as aseptic meningitis with CSF findings showing mild Likewise, there was an outbreak of West Nile virus lymphocytic pleocytosis and elevated protein. infection in New York, in 1999.15 Initial cases were reported by a physician who noted the unusual Until recently, the diagnosis of Whipple’s disease features of the disease, including encephalitis as well has depended on the demonstration of macrophages as profound weakness. The virus is now identified as containing periodic acid Schiff positive material in an arbovirus belonging to the group of flaviviruses intestinal and other biopsies. Recently, however, a (other members include St. Louis and Japanese B PCR technique for detection of the causative agent, encephalitis viruses), transmitted by mosquitoes from Tropherema whippeli, has been developed and success- birds to humans. This viral infection had not been fully applied to the CSF. Treatment of Whipple’s dis- seen in the United States prior to 1999 and it has been ease consists of intravenous ceftriaxone for a month, postulated that the
Load more

Recommended publications
  • Primary Cutaneous Nocardiosis: a Case Study and Review
    Study Primary cutaneous nocardiosis: A case study and review Arun C. Inamadar, Aparna Palit Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur, India. Address for correspondence: Dr. Arun C. Inamadar, Professor & Head, Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur - 586103, India. E-mail: [email protected]. ABSTRACT Background: Primary cutaneous nocardiosis is an uncommon entity. It usually occurs among immunocompetent but occupationally predisposed individuals. Aim: To study clinical profile of patients with primary cutaneous nocardiosis in a tertiary care hospital and to review the literature. Methods: The records of 10 cases of primary cutaneous nocardiosis were analyzed for clinical pattern, site of involvement with cultural study and response to treatment. Results: All the patients were agricultural workers (nine male) except one housewife. The commonest clinical type was mycetoma. Unusual sites like the scalp and back were involved in two cases. Culture was positive in six cases with N. brasiliensis being commonest organism. N. nova which was previously unreported cause of lymphocutaneous nocardiosis, was noted in one patient, who had associated HIV infection. All the patients responded to cotrimaxazole. Conclusion: Mycetoma is the commonest form of primary cutaneous nocardiosis and responds well to cotrimoxazole. KEY WORDS: Primary cutaneous nocardiosis, Mycetoma, Lymphocutaneous nocardiosis INTRODUCTION infection is prevalent. Many of the large series on nocardial infections mention the incidence of Cutaneous nocardiosis presents either as a part of cutaneous nocardiosis without specifying whether the disseminated infection or as a primary infection infection is primary or secondary. Indian reports of resulting from inoculation.
    [Show full text]
  • Intracranial Actinomycosis of Odontogenic Origin Masquerading As Auto-Immune Orbital Myositis: a Fatal Case and Review of the Literature G
    Hötte et al. BMC Infectious Diseases (2019) 19:763 https://doi.org/10.1186/s12879-019-4408-2 CASE REPORT Open Access Intracranial actinomycosis of odontogenic origin masquerading as auto-immune orbital myositis: a fatal case and review of the literature G. J. Hötte1,2*, M. J. Koudstaal3, R. M. Verdijk4, M. J. Titulaer5, J. F. H. M. Claes6, E. M. Strabbing3, A. van der Lugt7 and D. Paridaens1,2 Abstract Background: Actinomycetes can rarely cause intracranial infection and may cause a variety of complications. We describe a fatal case of intracranial and intra-orbital actinomycosis of odontogenic origin with a unique presentation and route of dissemination. Also, we provide a review of the current literature. Case presentation: A 58-year-old man presented with diplopia and progressive pain behind his left eye. Six weeks earlier he had undergone a dental extraction, followed by clindamycin treatment for a presumed maxillary infection. The diplopia responded to steroids but recurred after cessation. The diplopia was thought to result from myositis of the left medial rectus muscle, possibly related to a defect in the lamina papyracea. During exploration there was no abnormal tissue for biopsy. The medial wall was reconstructed and the myositis responded again to steroids. Within weeks a myositis on the right side occurred, with CT evidence of muscle swelling. Several months later he presented with right hemiparesis and dysarthria. Despite treatment the patient deteriorated, developed extensive intracranial hemorrhage, and died. Autopsy showed bacterial aggregates suggestive of actinomycotic meningoencephalitis with septic thromboembolism. Retrospectively, imaging studies showed abnormalities in the left infratemporal fossa and skull base and bilateral cavernous sinus.
    [Show full text]
  • Granulomatous Diseases: Disease: Tuberculosis Leprosy Buruli Ulcer
    Granulomatous diseases: Disease: Tuberculosis Leprosy Buruli ulcer MOTT diseases Actinomycosis Nocardiosis Etiology Mycobacterium M. leprae M. ulcerans M. kansasii Actinomyces israelii Nocardia asteroides tuberculosis M. scrofulaceum M. africanum M. avium- M. bovis intracellulare M. marinum Reservoir Humans (M. tuberculosis, HUMANS only Environment Environment HUMANS only Environment M. africanum*) (uncertain) Animals (M. bovis) Infects animals Transmission Air-borne route Air-borne route Uncertain: Air-borne NONE Air-borne route to humans Food-borne route Direct contact traumatic Traumatic inoculation endogenous infection Traumatic (M. bovis) inoculation, Habitat: oral cavity, inoculation insect bite? intestines, female genital tract Clinical Tuberculosis (TB): Leprosy=Hansen’s Disseminating Lung disease Abscesses in the skin Broncho-pulmonary picture pulmonary and/or disease skin ulcers Cervical lymphadenitis adjacent to mucosal surfaces (lung abscesses) extra-pulmonary Tuberculoid leprosy Disseminated (cervicofacial actinomycosis), Cutaneous infections (disseminated: kidneys, Lepromatous leprosy infection in the lungs (pulmonary) or such as: mycetoma, bones, spleen, meninges) Skin infections in the abdominal cavity lymphocutaneous (peritonitis, abscesses in infections, ulcerative appendix and ileocecal lesions, abscesses, regions) cellulitis; Dissemination: brain abscesses Distribution All over the world India, Brazil, Tropical disease All over the world All humans Tropical disease * Africa Indonesia, Africa (e.g. Africa, Asia, (e.g.
    [Show full text]
  • 17110-Disseminated-Nocardiosis-A-Case-Report.Pdf
    Open Access Case Report DOI: 10.7759/cureus.5294 Disseminated Nocardiosis: A Case Report Ines M. Leite 1 , Frederico Trigueiros 1 , André M. Martins 1 , Marina Fonseca 1 , Tiago Marques 2 1. Serviço De Medicina 2, Hospital De Santa Maria, Lisboa, PRT 2. Serviço De Doenças Infecciosas, Hospital De Santa Maria, Lisboa, PRT Corresponding author: Ines M. Leite, [email protected] Abstract Disseminated nocardiosis is a rare infection associated with underlying immunosuppression, and patients usually have some identifiable risk factor affecting cellular immunity. Due to advances in taxonomy and microbiology identification methods, infections by Nocardia species are more frequent, making the discussion of its approach and choice of antibiotherapy increasingly relevant. A 77-year-old man presented to the emergency department with marked pain on the right lower limb, weakness, and upper leg edema. He had been diagnosed with organized cryptogenic pneumonia one year before and was chronically immunosuppressed with methylprednisolone 32 mg/day. Blood cultures isolated Nocardia cyriacigeorgica. Computed tomography revealed a gas collection in the region of the right iliacus muscle with involvement of the gluteal and obturator muscles upwardly and on the supragenicular plane inferiorly. Triple therapy with imipenem, amikacin, and cotrimoxazole was started, and the patient was submitted for emergent surgical decompression, fasciotomy, and drainage due to acute compartment syndrome. The patient had a good outcome and was discharged from the hospital after 30 days of intravenous therapy. This case illustrates the severity of Nocardia infection and highlights the need for a meticulous approach in the diagnosis and treatment of these patients. Categories: Internal Medicine, Infectious Disease Keywords: nocardia, nocardia infection, immunosuppression Introduction In the suborder of Corynebacterineae, three genera have strains that may be pathological to humans, with some characteristics similar to Fungi: Mycobacterium, Corynebacterium, and Nocardia.
    [Show full text]
  • Viral Encephalitis and Meningitis
    Peachtree Street NW, 15th Floor Atlanta, Georgia 30303-3142 Georgia Department of Public Health www.health.state.ga.us Viral Encephalitis and Viral (Aseptic) Meningitis Frequently Asked Questions What are viral encephalitis and viral meningitis? Viral encephalitis is inflammation (or swelling) of the brain caused by a viral infection. Symptoms of viral encephalitis include headache, fever, stiff neck, seizures, changes in consciousness such as confusion or coma, and sometimes death. Viral (or aseptic) meningitis is also caused by a viral infection resulting in inflammation (or swelling) of the meninges, the protective covering of the brain and spinal cord. The symptoms of viral meningitis are similar to those of viral encephalitis, although loss of or changes in consciousness are not common symptoms of viral meningitis. Viral and bacterial meningitis are not caused by the same organisms, and viral meningitis is usually not as serious as bacterial meningitis. What causes viral encephalitis and viral (aseptic) meningitis? Organisms called viruses cause viral encephalitis and viral meningitis. Many different types of viruses cause these illnesses. Some of these viruses can be passed from person to person, such as when people (especially young children) do not practice good hygiene by washing their hands thoroughly. Other viruses can be passed to people through the bites of infected mosquitoes or ticks. When do most cases of viral encephalitis and viral meningitis occur? Viral encephalitis and viral meningitis occur year‐round. Encephalitis from mosquito bites usually occurs in the late summer and fall, when mosquitoes are most active. Tick‐borne viral encephalitis usually occurs in the spring and early summer, although cases of tick‐borne encephalitis have never been documented in Georgia.
    [Show full text]
  • Cerebrospinal Fluid in Critical Illness
    Cerebrospinal Fluid in Critical Illness B. VENKATESH, P. SCOTT, M. ZIEGENFUSS Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, QUEENSLAND ABSTRACT Objective: To detail the physiology, pathophysiology and recent advances in diagnostic analysis of cerebrospinal fluid (CSF) in critical illness, and briefly review the pharmacokinetics and pharmaco- dynamics of drugs in the CSF when administered by the intravenous and intrathecal route. Data Sources: A review of articles published in peer reviewed journals from 1966 to 1999 and identified through a MEDLINE search on the cerebrospinal fluid. Summary of review: The examination of the CSF has become an integral part of the assessment of the critically ill neurological or neurosurgical patient. Its greatest value lies in the evaluation of meningitis. Recent publications describe the availability of new laboratory tests on the CSF in addition to the conventional cell count, protein sugar and microbiology studies. Whilst these additional tests have improved our understanding of the pathophysiology of the critically ill neurological/neurosurgical patient, they have a limited role in providing diagnostic or prognostic information. The literature pertaining to the use of these tests is reviewed together with a description of the alterations in CSF in critical illness. The pharmacokinetics and pharmacodynamics of drugs in the CSF, when administered by the intravenous and the intrathecal route, are also reviewed. Conclusions: The diagnostic utility of CSF investigation in critical illness is currently limited to the diagnosis of an infectious process. Studies that have demonstrated some usefulness of CSF analysis in predicting outcome in critical illness have not been able to show their superiority to conventional clinical examination.
    [Show full text]
  • Evaluation of the Various Clinical Presentations Of
    EVALUATION OF THE VARIOUS CLINICAL PRESENTATIONS OF ADULT CNS TUBERCULOSIS JOY KMNI1, KUNDU NC2, AKHTER M3, HOSSAIN MZ4, RAHMAN AHMW5, RAHMAN MM6, SAIFULLAH M7, ROUF MA8, HAQUE MM9 Abstract: Background: Central nervous system (CNS) involvement is one of the most important extra- pulmonary manifestations of tuberculosis (TB) causing considerable mortality and morbidity. Presentations of CNS TB are extremely variable. Treatments are generally more effective if the disease can be detected early. This study is to find out the various clinical patterns and investigation findings that might help in early detection of CNS TB. Objective: This study was conducted to detect various clinical manifestations of adult CNS TB at an earlier stage of evaluation. Methods: This was a hospital based observational study (cross sectional type) conducted on 30 patients of CNS TB who were admitted in Sir Salimullah Medical College Mitford Hospital, Dhaka during a period of 6 months from October 2013 to April 2014 . Results: Among the participants 53% were male and 47% were female, with a male female ratio of 1.13: 1. Mean age of the participants was 35.17±6.14 years. Tuberculosis involving brain (i.e. cranial TB) was most common (30.4%) in 15-24 years age group whereas spinal form of TB was most common (42.8%) in 25-34 years age group. Mean age of the participants having Brain TB was 36.46±6.90 years. Mean age of the participants having spinal TB was 32.36±12.52 years. Highest number of the cranial forms of TB was tuberculoma (52.2%) in this study and was found mostly in the young adults.
    [Show full text]
  • Introduction Neuroimaging of the Brain
    Introduction Neuroimaging of the Brain John J. McCormick MD Normal appearance depends on age Trauma • One million ER visits/yr • 80,000/yr develop long term disability • 50,000/yr die • 46% from transportation; 26% falls; 17% assaults. Other causes, such as sports injuries, account for rest. • 2/3 < 30yrs old • Men 2X as likely to be injured • Cost of TBI is $48.3 billion annually • A patient in mid-twenties with severe head injury is estimated to have a lifetime cost of 4 million dollars including lost work hours, medical and daily care Skull Fracture • Linear or depressed • Skull base, middle meningeal artery • Differentiate from suture and venous channels Sutures Traumatic Subarachnoid Hemorrhage Acute Subdural Hemorrhage Subacute Subdural Hematoma Chronic Subdural Hemorrhage Epidural Hematoma Diffuse Axonal Injury Coup-Contracoup Intraventricular Hemorrhage Stroke National Stroke Ass’n Stats • Third leading cause of death in US • Someone suffers stroke every 53 seconds and every 3.3 minutes someone dies of a stroke • 28% of those who suffer from stroke are under 65 • 15-30% are permanently disabled and require institutional care • Estimated direct and indirect annual cost of stroke un US is 43.4 billion dollars Stroke Subtypes • Two major types: hemorrhagic and ischemic • Hemmorrhagic strokes caused by blood vessel rupture and account for 16% of strokes • Ischemic strokes include thrombotic, embolic, lacunar and hypoperfusion infarctions Intracebral Hemorrhage • Most common cause: hypertensive hemorrhage • Other causes: AVM, coagulopathy,
    [Show full text]
  • Successful Management of Nosocomial Ventriculitis and Meningitis Caused by Extensively Drug-Resistant Acinetobacter Baumannii in Austria
    CASE REPORT Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumannii in Austria M Hoenigl MD1,2*, M Drescher1*, G Feierl MD3, T Valentin MD1, G Zarfel PhD3, K Seeber MSc1, R Krause MD1, AJ Grisold MD3 M Hoenigl, M Drescher, G Feierl, et al. Successful management La prise en charge réussie d’une ventriculite et of nosocomial ventriculitis and meningitis caused by extensively d’une méningite d’origine nosocomiale causées par drug-resistant Acinetobacter baumannii in Austria. Can J Infect un Acinetobacter baumannii d’une extrême Dis Med Microbiol 2013;24(3):e88-e90. résistance aux médicaments en Autriche Nosocomial infections caused by the Gram-negative coccobacillus Les infections d’origine nosocomiale causées par le coccobacille Acinetobacter baumannii have substantially increased over recent years. Acinetobacter baumannii Gram négatif ont considérablement augmenté Because Acinetobacter is a genus with a tendency to quickly develop ces dernières années. Puisque l’Acinetobacter est un genre qui a ten- resistance to multiple antimicrobial agents, therapy is often compli- dance à devenir rapidement résistant à de multiples agents antimicro- cated, requiring the return to previously used drugs. The authors report biens, le traitement est souvent compliqué et exige de revenir à des a case of meningitis due to extensively drug-resistant A baumannii in an médicaments déjà utilisés. Les auteurs signalent un cas de méningite Austrian patient who had undergone neurosurgery in northern Italy. attribuable à un A baumannii d’une extrême résistance aux médica- The case illustrates the limits of therapeutic options in central nervous ments chez un patient autrichien qui a subi une neurochirurgie dans le system infections caused by extensively drug-resistant pathogens.
    [Show full text]
  • Case Report Left Lateral Cervical Mass with Draining Sinuses
    Hindawi Case Reports in Medicine Volume 2019, Article ID 7838596, 6 pages https://doi.org/10.1155/2019/7838596 Case Report Left Lateral Cervical Mass with Draining Sinuses Stylianos A. Michaelides ,1,† George D. Bablekos ,2 Avgerinos-Romanos Michailidis,1 Efthalia Gkioxari,3 Stephanie Vgenopoulou,4 and Maria Chorti4 1Department of Occupational Lung Diseases and Tuberculosis, “Sismanogleio- Amalia Fleming” General Hospital, 1 Sismanogleiou Str, 15126, Attiki, Maroussi, Athens, Greece 2Departments of Biomedical Sciences, Nursing and Physiotherapy, University of West Attica, Campus 1, Attiki, Egaleo, Agiou Spiridonos, 12243 Athens, Greece 3Second Department of 2oracic Medicine, “Sismanogleio- Amalia Fleming” General Hospital, 1 Sismanogleiou Str, 15126, Attiki, Maroussi, Athens, Greece 4Department of Surgical Pathology, “Sismanogleio- Amalia Fleming” General Hospital, 1 Sismanogleiou Str, 15126, Attiki, Maroussi, Athens, Greece †Deceased Correspondence should be addressed to George D. Bablekos; [email protected] Received 3 January 2019; Accepted 27 May 2019; Published 25 July 2019 Academic Editor: Gerd J. Ridder Copyright © 2019 Stylianos A. Michaelides et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. *e aim of the present study is to describe an uncommon case of tuberculous lymphadenitis (TL) in a symptomless 89-year-old male smoker patient, who presented at the emergency department of our hospital with left lateral cervical swelling with draining sinuses. No other clinical symptoms or physical findings were observed at admission. An elevated erythrocyte sedimentation rate (ESR) and a small calcified nodule in chest CT were the only abnormal findings.
    [Show full text]
  • Of CMV Ventriculitis CMV Ventriculoencephalitis Is Characterized by Sub- Acute Delirium, Cranial Neuropathies, and Nystagmus
    Alzhemier’s disease in women: randomized, double-blind, 23. Crystal H, Dickson D, Fuld P, et al. Clinico-pathologic studies placebo-controlled trial. Neurology 2000;54:295–301. in dementia-nondemented subjects with pathologically con- 22. Mulnard RA, Cotman CW, Kawas C, et al. Estrogen replace- firmed Alzheimer’s disease. Neurology 1988;38:1682–1687. ment therapy for treatment of mild to moderate Alzheimer’s 24. Price JL, Morris JC. Tangles and plaques in nondemented disease: a randomized control trial. Alzheimer’s Disease aging and “preclinical” Alzheimer’s disease. Ann Neurol 1999; Coopertive Study. JAMA 2000;283:1007–1015. 45:358–368. NeuroImages Figure. (A) Fluid-attenuated inversion recovery MRI sequence demonstrates prominent abnormal signal outlining the ventricles. (B) Cytomegalovirus (CMV)-infected macrophages in a patient with CMV ventriculoencephalitis. “Owl’s eyes” of CMV ventriculitis CMV ventriculoencephalitis is characterized by sub- acute delirium, cranial neuropathies, and nystagmus. The Devon I. Rubin, MD, Rochester, MN pathologic hallmark is the cytomegalic cell, a macrophage A 35-year-old HIV-positive man with a history of cyto- containing intranuclear and intracytoplasmic inclusions of megalovirus (CMV) retinitis presented with fever, diplopia, cytomegalic virus particles, resembling and referred to as and progressive obtundation over 1 week. Neurologic ex- “owl’s eyes” (figure, B). MRI findings in CMV ventriculoen- amination revealed a fluctuating level of alertness, bilat- cephalitis include diffuse cerebral atrophy, progressive eral gaze-evoked horizontal nystagmus, a left facial palsy, ventriculomegaly, and a variable degree of periventricular and diffuse areflexia. MRI demonstrated generalized atro- or subependymal contrast enhancement.1 Newer imaging phy and ventriculomegaly with increased signal in the left sequences, such as FLAIR, may be more sensitive in de- caudate head on T1-weighted, gadolinium-enhanced im- tecting ventricular abnormalities.
    [Show full text]
  • A Diagnostic Rule for Tuberculous Meningitis Arch Dis Child: First Published As 10.1136/Adc.81.3.221 on 1 September 1999
    Arch Dis Child 1999;81:221–224 221 A diagnostic rule for tuberculous meningitis Arch Dis Child: first published as 10.1136/adc.81.3.221 on 1 September 1999. Downloaded from Rashmi Kumar, S N Singh, Neera Kohli Abstract onstration of mycobacteria in cerebrospinal Diagnostic confusion often exists between fluid (CSF), by direct staining or culture. tuberculous meningitis and other menin- However, these tests are time consuming and goencephalitides. Newer diagnostic tests seldom positive.2 Recognising this problem of are unlikely to be available in many coun- diagnosis, many newer tests have been devel- tries for some time. This study examines oped to diagnose tuberculous meningitis and which clinical features and simple labora- diVerentiate it from pyogenic meningitis—for tory tests can diVerentiate tuberculous example, enzyme linked immunosorbent assay, meningitis from other infections. Two bromide partition test, tuberculostearic acid in hundred and thirty two children (110 CSF, adenosine deaminase in CSF, polymerase tuberculous meningitis, 94 non- chain reaction, etc.34 However, the sensitivity tuberculous meningitis, 28 indeterminate) of these tests is still under study and they are with suspected meningitis and cerebrospi- unlikely to be available where they are really nal fluid (CSF) pleocytosis were enrolled. needed for at least the next decade. In practice, Tuberculous meningitis was defined as in India, treatment is started solely on the basis positive CSF mycobacterial culture or of clinical features and results of simple labora- acid fast bacilli stain, or basal enhance- tory tests of CSF and blood. Therefore, we ment or tuberculoma on computed tomo- attempted to establish a clinical rule for the graphy (CT) scan with clinical response to diagnosis of tuberculous meningitis, whereby a antituberculous treatment.
    [Show full text]