Total antioxidant/oxidant status in meningism and meningitis

The objective of this study was to investigate the antioxidant/oxidant status of serum and cerebrospinal fluid in children with meningismus and acute bacterial meningitis. Twenty-three children (age range, 0.75 to 9 years) with fever and meningeal signs that required analysis of the cerebrospinal fluid, but no cytologic or biochemical evidence of meningitis in their serum and cerebrospinal fluid, constituted the meningismus group. Thirty-one children (age range, 0.5 to 10 years) with acute bacterial meningitis constituted the meningitis group. Twenty-nine healthy children (age range, 0.5 to 11 years) were recruited as control subjects. Antioxidant status (ascorbic acid, albumin, thiol, uric acid, total bilirubin, total antioxidant capacity, catalase and ceruloplasmin concentrations) and oxidant status (lipid hydroperoxide and total oxidant status) were measured. The serum antioxidant status was lower, and oxidant status levels higher in both meningitis and meningismus subjects than in the control children (P < 0.001). Cerebrospinal fluid oxidant status was lower in the meningitis group than in the meningismus group (P < 0.05). These results indicate that serum antioxidant status was lower, and serum oxidant status was higher in children in the meningismus and meningitis groups, whereas cerebrospinal fluid oxidant status was higher in the meningismus group than in the meningitis group.     

Evaluation of antioxidant status in children with acute bacterial meningitis and encephalitis

Antioxidant status was investigated in children with acute bacterial meningitis and encephalitis to investigate the possible role of free radicals in children with meningitis and encephalitis. Our study included 16 children with acute bacterial meningitis, 13 with encephalitis, and 17 control subjects. Serum ceruloplasmin, uric acid, albumin, bilirubin superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) levels were studied in all subjects within 6 h of admission. There was a statistically significant difference between the groups for all parameters except for serum uric acid. All antioxidant activities except for albumin level were increased in the study groups. Albumin level was higher in the control group than those of meningitis and encephalitis groups. When the values of meningitis and encephalitis were compared, there was a statistically significant difference between the groups for serum SOD, GPx, ceruloplasmin, and albumin. In conclusion, our study showed that serum SOD, GPx, catalase, and ceruloplasmin were higher in children with acute bacterial meningitis and serum SOD, GPx, catalase, ceruloplasmin, and total bilirubin levels were increased in children with encephalitis. These findings suggest that antioxidant status was almost similar in both acute bacterial meningitis and encephalitis conditions in childhood.     

Imipramine reverses depressive-like parameters in pneumococcal meningitis survivor rats

Pneumococcal meningitis is a severe infectious disease of the central nervous system, associated with acute inflammation and might cause damage to the host, such as deafness, blindness, seizure, and learning deficits. However, infectious diseases can play a significant role in the etiology of neuropsychiatric disturbances. In this context, we evaluated depressive-like parameters; corticosterone and ACTH levels in pneumococcal meningitis surviving rats. Wistar rats underwent a magna cistern tap receiving either 10 μL sterile saline or a Streptococcus pneumoniae suspension at the concentration of 5 × 10(9) cfu/mL. After 3 days of meningitis induction procedure, the animals were treated with imipramine at 10 mg/kg or saline for 14 days (3rd-17th day). The consumption of sweet food was measured for 7 days (10th-17th day). The meningitis group decreased the sucrose intake and increased the levels of corticosterone and ACTH levels in the serum and TNF-α in the cortex; however, the treatment with imipramine reverted the reduction of sweet food consumption, normalized hormonal levels and TNF-α in the cortex. Our results supported the hypothesis that the pneumococcal meningitis surviving rats showed depressive-like behavior and alterations in the hypothalamus-pituitary-adrenal axis.     

Cerebrospinal fluid parameters and auditory brainstem responses following meningitis

Auditory brainstem responses were measured in 94 children under 24 months of age immediately following treatment for bacterial meningitis. Evidence of peripheral hearing loss (thresholds of 30 dB HLn or greater) was found in 47% of the patients. In addition, 9% had prolonged interwave latencies, indicating the possible presence of retrocochlear pathology. Other clinical data were examined as well. CSF glucose concentration correlated with both the presence and magnitude of hearing loss (as measured by auditory brainstem responses). Magnitude of hearing loss also was associated with the presence of seizures. Although all children recovering from meningitis should be assessed for hearing loss, those who have had low CSF glucose concentrations and seizures appear to be at high risk.     

Oxidant treatment causes a dose-dependent phenotype of apoptosis in cultured motoneurons

Evidence is growing that reactive oxygen species (ROS), by-products of (normal) cellular aerobic metabolism, are involved in the pathogenesis of neurodegenerative diseases. One of these diseases is amyotrophic lateral sclerosis (ALS), in which motoneurons die, leading to paralysis and death. It remains uncertain whether ROS are the cause of (apoptotic) motoneuron death in ALS. To further understand the role of ROS in motoneuron death, we investigated the effects of ROS on isolated spinal rat motoneurons in culture. ROS were generated with a combination of iron(III) and ascorbate, or with hydrogen peroxide. Both toxic treatments resulted in a dose-dependent motoneuron death. Iron(III)/ascorbate toxicity was completely prevented with the hydrogen peroxide detoxifying enzyme catalase and partially prevented with the antioxidant vitamin E. SOD1, the enzyme that removes superoxide, did not protect against iron(III)/ascorbate toxicity. ROS treatment caused apoptotic motoneuron death: low doses of iron(III)/ascorbate or hydrogen peroxide resulted in complete apoptosis ending in nuclear fragmentation, while high doses of ROS resulted in incomplete apoptosis (nuclear condensation). Thus, depending on the dose of ROS, the motoneurons complete the apoptotic pathway (low dose) or are stopped somewhere during this route (high dose). J. Neurosci. Res. 54:778–786, 1998. © 1998 Wiley-Liss, Inc.     

结核性脑膜脑炎的综合治疗

目的探讨结核性脑膜脑炎(TBM),尤其是重症TBM的诊断及综合治疗。方法对32例结核性脑膜脑炎的临床表现、客观检查及抗结核化疗方案等综合治疗进行总结分析。结果 32例病例中死亡3例,治愈29例,其中一次性治愈24例,复发后再次治愈5例;32例全部行静脉及鞘内注射抗痨药物等综合治疗,其中行侧脑室引流5例,行脑室腹腔引流术3例。结论 TBM的早期诊断及综合治疗是改善预后、降低死亡率的重要因素。     

Bacterial meningitis: Diagnosis and treatment

Bacterial meningitis, once almost universally fatal, remains a cause of serious neurologic illness and subsequent disability. The initial diagnosis, although sometimes clear-cut, can be subtle and difficult. Appropriate intervention may have a favorable influence on outcome. The advent of corticosteroids and brain imaging has improved management but created controversy concerning the sequence at which various interventions should be introduced. Empiric treatment with antibiotics is important in the initial stages. Complications can arise, such as seizures, increased intracranial pressure, and ischemia. The prognosis remains unfavorable for some affected individuals in spite of advances in antibiotic management and supportive care.     

颅脑手术后无菌性脑膜炎的诊断和治疗

颅脑手术后无菌性脑膜炎在临床上常易同颅内感染混淆，导致了不必要及不合理抗生素的使用和住院时间的延长，本文总结10年来68例术后无菌性脑膜炎患者的诊治情况，结合文献进行讨论。[第一段]     

氯霉素联合青霉素治疗小儿难治性化脓性脑膜炎

目的探讨氯霉素联合青霉素对小儿难治性化脓性脑膜炎的治疗效果。方法对我科近5a来收治的27例难治性化脓性脑膜炎患儿应用氯霉素联合青霉素治疗,并对结果进行分析。结果所有27例患儿均临床治愈,达到出院标准,未出现明显不良反应。结论对小儿难治性化脓性脑膜炎可选择氯霉素联合青霉素进行治疗,安全有效。     

Use of urokinase in the treatment of tuberculous meningitis hydrocephalus

We present a patient with hydrocephalus after tuberculous meningitis successfully treated with urokinase. She presented with multiple episodes of headache, fever, and vomiting. She underwent external ventricular drainage and was treated with urokinase in addition to dexamethasone, acetazolamide, and 4 antituberculous drugs. She was evaluated clinically, radiologically, and by laboratory work-up. On short-term clinical follow-up (3 months), she was asymptomatic after the treatment with urokinase. She was radiologically evaluated 3 weeks after the treatment. An MRI of the brain showed a decrease in ventricular size. Urokinase can be considered as a safe and promising adjunctive treatment for tuberculous meningitis hydrocephalus.     

Adjunctive dexamethasone treatment in acute bacterial meningitis

The initiation of antibiotic treatment on suspicion of bacterial meningitis is important, but it is not enough to improve the prognosis for patients, especially those with pneumococcal meningitis. The mortality and morbidity of pneumococcal meningitis are still devastating, and results of a recent randomised trial have shown evidence in favour of dexamethasone treatment given before or with the first antibiotic dose. Adjuvant dexamethasone is unequivocally recommended in children and adults with haemophilus meningitis or pneumococcal meningitis. The benefit of adjunctive dexamethasone is likely to be greatest in patients who are otherwise healthy and present early with acute bacterial meningitis. Dexamethasone is not currently recommended for the treatment of gram-negative bacillary meningitis and neonatal meningitis. Dexamethasone, before or with the first dose of antibiotic, is likely to be one of the most significant practice changes that will benefit many adults and children with common types of acute bacterial meningitis and has been of proven value in the developed world.     

Vancomycin treatment for enterococcal meningitis

Although clinical disease due to enterococcus is common, there has been only limited experience in the treatment of central nervous system infections by this pathogen. In particular, there have been few reports regarding the treatment of such infections in the penicillin-allergic individual. We present two cases of meningitis due to enterococci, including one case with a brain abscess, in patients with strong histories of penicillin sensitivity. We treated these patients with vancomycin hydrochloride and an aminoglycoside. Vancomycin with an aminoglycoside seems to be a reasonable treatment for enterococcal central nervous system infections.     

Bacterial meningitis in children: pathophysiology and treatment.

Recent studies of the pathophysiology of bacterial meningitis have suggested that the development of neuronal injury is related to the release of vasoactive substances or alteration of blood-brain barrier permeability. Cerebral edema, increased intracranial pressure (ICP), systemic hypotension, decreased cerebral perfusion pressure, vascular inflammation, thrombosis, and a variety of other vascular changes may result in global or regional reductions in cerebral blood flow (CBF), which contribute to this insult. Approximately one-third of infants and children with bacterial meningitis will have markedly reduced CBF, and even in those children with normal total flow, regional hypoperfusion is common. Reduced CBF is associated with cerebral edema and a poor prognosis. A poor prognosis also is associated with reduced cerebral perfusion pressure. This occurs early in the course of meningitis and is primarily due to increased ICP rather than systemic hypotension. Autoregulation is preserved, suggesting that local ischemic tissue injury is more related to factors such as regional edema formation, focal vascular pathology, or specific intrinsic flow/metabolic abnormalities than to a reduction in systemic blood pressure. In contrast with other acute CNS insults, CBF/PCO2 reactivity is well preserved in many patients with meningitis; this raises the possibility that hyperventilation may cause further ischemic injury in those patients with marginal CBF. Although it is still unclear that treatment of increased ICP will affect outcome, we propose a treatment paradigm based on the results of neuroimaging studies and ICP measurements.     

Impaired cortical energy metabolism but not major antioxidant defenses in experimental bacterial meningitis

The loss of soluble brain antioxidants and protective effects of radical scavengers implicate reactive oxygen species in cortical neuronal injury caused by bacterial meningitis. However, the lack of significant oxidative damage in cortex [J. Neuropathol. Exp. Neurol. 61 (2002) 605-613] suggests that cortical neuronal injury may not be due to excessive parenchymal oxidant production. To see whether this tissue region exhibits a prooxidant state in bacterial meningitis, we examined the state of the major cortical antioxidant defenses in infant rats infected with Streptococcus pneumoniae. Adenine nucleotides were co-determined to assess possible changes in energy metabolism. Arguing against heightened parenchymal oxidant production, the high NADPH/NADP(+) ratio ( approximately 3:1) and activities of the major antioxidant defense and pentose phosphate pathway enzymes remained unchanged at the time of fulminant meningitis. In contrast, cortical ATP, ADP and total adenine nucleotides were on average decreased by approximately 25%. However, energy depletion did not lead to a significant decrease in adenylate energy charge (AEC). ATP depletion was likely a consequence of metabolic degradation, since it correlated with both the loss of total adenine nucleotides and accumulation of purine degradation products. Furthermore, the loss of ATP and decrease in AEC correlated significantly with the extent of neuronal injury. These results strongly suggest that energy depletion rather than parenchymal oxidative damage is involved in the observed cortical neuronal injury.     

糖皮质激素治疗结核性脑膜炎的临床疗效

目的探讨糖皮质激素冲击治疗结核性脑膜炎患者的临床效果和安全性。方法选取我院收治的80例结核性脑膜炎患者为研究对象,采用完全随机分组方法分为观察组(糖皮质激素冲击+抗结核实验组)40例和对照组(单纯抗结核实验组)40例,观察2组间实验指标,比较2组治疗效果。结果观察组好转率95.0%,显著高于对照组80.0%,差异有统计学意义(P0.05);观察组脑脊液细胞数和蛋白质含量均较对照组降低明显,且差异有统计学意义(P0.05);观察组脑脊液葡萄糖和氯化物含量均较对照组显著升高,差异有统计学意义(P0.05);观察组发热、脑膜刺激征、颅内高压、昏迷症状消失时间明显早于对照组,差异均有统计学意义(P0.05)。结论糖皮质激素冲击治疗可有效改善结核性脑膜炎患者病情,提升治疗效果,改善患者预后。