Detection of Cysticercus antigens and antibodies in cerebrospinal fluid of patients with chronic meningitis

Chronic meningitism is a less frequent manifestation of neurocysticercosis caused by Taenia solium cysticerci. In the present study we used Co-agglutination (Co-A), a simple and rapid slide agglutination test to detect specific Cysticercus antigen in the 67 cerebrospinal fluid (CSF) samples from patients with chronic meningitis of unknown etiology. The results were compared with that of ELISA for detection of antibodies. Among these samples four (5.97%) were positive for Cysticercus antigen by Co-A test and six (8.95%) were positive for antibodies by ELISA. Two samples were positive by both Co-A and ELISA, two were positive only by Co-A and four were positive only by ELISA. In the present study, although Cysticercus antigen and antibodies were present in CSF samples from eight (11.94%) patients, we cannot affirm that all the cases of chronic meningitis are due to cysticercosis, but for any case of chronic meningitis of unknown origin, it would be useful to consider the possibility of cysticercal meningitis.     

A rapid latex agglutination test for the detection of anti-cysticercus antibodies in cerebrospinal fluid (CSF)

Simple and rapid latex-based diagnostic tests have been used for detecting specific antigens or antibodies in several diseases. In this article, we present the preliminary results obtained with a latex agglutination test (LAT) for diagnosing neurocysticercosis by detection of antibodies in CSF. A total of 43 CSF samples were assayed by the LAT: 19 CSF samples from patients with neurocysticercosis and 24 CSF samples from patients with other neurologic disorders (neurosyphilis, n = 8; neurotoxoplasmosis, n = 3; viral meningitis, n = 4, chronic headache, n = 9). The LAT exhibited 89.5% sensitivity and 75% specificity. The use of LAT seems to be an additional approach for the screening of neurocysticercosis with advantage of simplicity and rapidity. Further studies could be performed using purified antigens and serum samples.     

脑囊尾蚴病患者脑脊液一氧化氮含量分析

目的　探讨脑囊尾蚴病患者脑脊液 (CSF)一氧化氮 (NO)含量以及细胞学成分变化。　方法　采用 Griess法检测 30例脑囊尾蚴病、2 0例结核性脑膜炎 (TBM)及 2 0名健康人 (对照组 ) CSF的 NO水平 ,同时进行其细胞学成分分析。　结果与结论　Griess法能快速、准确地检测 CSF的 NO含量。脑囊尾蚴病组及 TBM组 CSF的 NO水平均明显高于对照组 (P<0 .0 1)。脑囊尾蚴病组 NO水平明显高于 TBM组 (P<0 .0 5 ) ,并以持续的嗜酸性粒细胞增多为主要特点。     

Immunoenzymatic test for the detection of anti-Cysticercus cellulosae antibodies in cerebrospinal fluid of patients with meningitis of unknown etiology

The enzyme-linked-immunosorbent assay using a new type of support consisting of discs of synthetic fabric-resin (ELISA-d) with antigenic components of Cysticercus cellulosae covalently bound, was employed with the purpose of investigating the presence of specific antibodies to the cysticerci (neurocysticercosis) in the cerebrospinal fluid (CSF) of patients with meningitis without etiological agent determined by the conventional methods. The test was performed in 277 CSF samples (128 children and 149 adults). The mean of optical density values (OD) obtained for 22 CSF normal patients (the diagnostic hyphotesis of meningitis was discarded) was of 0.03. The 44 CSF of patients with meningitis caused by other agents but C. cellulosae, showed OD of 0.05. The cut off determined with these two groups (control group) was 0.13 (OD + 3 SD). The group of 13 CSF of neurocysticercotic meningitis presented OD of 0.41 (0.10 to 0.91). Among the 198 CSF samples of indetermined meningitis, 23 (11.6%) presented OD above the cut off, which suggests the possibility that Cysticercus cellulosae was the etiological agent in this meningitis episode. The ELISA-d test has proved to be efficient for the immunodiagnosis of neurocysticercosis when conducted on CSF samples. The alterations observed in the 23 CSF reactive on ELISA-d were: increased number of lymphomononuclear cells in five, of polymorphonuclear cells in 13 and both cells in five samples.     

Neurocysticercosis as an important differential of paradoxical response during antituberculosis therapy in HIV–negative patient

Neurocysticercosis can simulate a paradoxical response during antituberculosis therapy with neurological ailments. We report the case of a 31 year-old-man, treated for tuberculous meningitis who developed neurological deficit after nine weeks of early antituberculous therapy. The diagnosis of neurocysticercosis was confirmed by CT scan and cerebrospinal fluid analysis. Neurocysticercosis should be sought as an important differential of paradoxical response during antituberculosis therapy.     

Chronic meningitis: aetiologies,diagnosis and treatment

PURPOSE: Chronic meningitis are very uncommon and account for less than 10% of all meningitis cases. Their symptoms are uncunth and there outcome is insidious. Therefore, they remain often unknown. There are only a few published reports on this disease, so diagnosis and therapeutic approachs are difficult. CURRENT KNOWLEDGE AND KEY POINTS: Positive chronic meningitis diagnosis is easy. However, determining the cause of chronic meningitis remains dilemma, as many infectious and noninfectious processes (including inflammatory, neoplastic or autoimmune aetiologies or as a result of a chemical exposure) can result in the chronic meningitis syndrome. In order to institute a pertinent treatment, sometimes urgently needed, diagnostic approach must be extremely rigourous and accutely orientated. Nevertheless, although extensive investigations, 30% of the aetiologies remain undetermined. Only two choices are left for the medical physician: an aggressive attitude based on complementary investigations or a contemplated therapy with a close clinical and biological control. On the other hand, when the patient's condition is quickly deterioring without a clear and proved aetiology, it is sometimes necessary to institute an empirical treatment, not always properly determined and sometimes contreversial. Besides, few reports on prognosis and outcome od idiopathic chronic meningitis have been published. FUTURE PROSPECTS AND PROJECTS: After a review of aetiologies and diagnostic investigations chronic meningitis, we propose a practical experience attitude about management and treatment of chronic meningitis. Thus, large-scale studies about the follow up chronic meningitis in long term, in particular those without aetiology, treated or no, should improve the outcome of this chronic syndrome.     

Idiopathic steroid responsive chronic lymphocytic meningitis—clinical features and long-term outcome in 17 patients

Background : Some patients with chronic lymphocytic meningitis appear to respond to corticosteroid treatment, but investigations fail to identify the cause. The use of corticosteroids in patients with chronic meningitis is controversial and the long term outcome is unclear.
Aim : To review the long term outcome in 17 patients with the syndrome of idiopathic steroid responsive chronic lymphocytic meningitis.
Methods : Review of patients' records and examination of surviving patients 1.5 to 17.5 years (median 8.8 years) after presentation.
Results : The cause of the steroid responsive chronic meningitis was found during follow up in two of the 17 patients: Wegener's granulomatosis and multiple sclerosis in one patient each. A cause was not found in the other 15 patients. Seven of these patients eventually recovered and corticosteroids were withdrawn after six weeks to six years without a recurrence of symptoms. Four patients improved transiently, but died six months to 26 years after starting treatment; in two, steroids were withdrawn a few weeks before death. Four patients had active chronic meningitis and reduction in the dose of corticosteroids was associated with a recurrence of symptoms. Leptomeningeal and brain biopsy in eight patients showed non-specific abnormalities which were not helpful in the diagnosis.
Conclusions : A subgroup of patients with idiopathic chronic lymphocytic meningitis responds to corticosteroids. Leptomeningeal biopsy and long term follow up seldom identify the underlying cause in these patients. Steroid treatment must be undertaken with caution, even after infective causes of chronic meningitis have been excluded.     

Disseminated intracranial tuberculoma mimicking neurocysticercosis

Intracranial tuberculoma and neurocysticercosis (NCC) are the most frequent granulomatous infections in the central nervous system. Here we report a 41-year-old man with disseminated intracranial tuberculoma mimicking NCC. The patient complained of relapsing vertigo and vomiting consistent with Bruns syndrome. Serum antibodies against cysticercosis were positive. Magnetic resonance imaging (MRI) of the brain showed multiple disseminated ring-enhanced lesions. An initial diagnosis of NCC was made based on clinical signs and MRI. However, during antiparasitic treatment, the patient exhibited fever, meningitis signs, and positive cerebrospinal fluid findings for tuberculosis. The diagnosis was therefore corrected as tuberculoma. After three months of antituberculous treatment, the patient recovered clinically and on MRI. Our results highlight the importance of differential diagnosis of these two diseases in the early stage.     

Leptomeningeal and brain biopsy in chronic meningitis

Background: The cause is not found in one third of patients presenting with chronic meningitis. Biopsy of the leptomeninges and brain is often recommended in these patients, but the value of a biopsy is uncertain. Aims: To review the results of leptomeningeal and brain biopsies and their effect on diagnosis and management in patients with chronic meningitis, if the diagnosis was uncertain after clinical assessment, lumbar puncture and radiological investigations. Methods: The clinical features, investigations and the results of leptomeningeal and brain biopsies were reviewed retrospectively in 25 patients presenting with chronic meningitis between 1967 and 1990. Results: The biopsy identified the cause of the chronic meningitis in five patients (neoplastic meningitis in three, tuberculous meningitis in one, granulomatous angiitis in one). In 17 patients the biopsy was abnormal but it did not identify the cause (non-gran-ulomatous lymphocytic meningitis in eight, granulomatous meningitis in two, non-specific abnormalities in seven). In two patients the biopsy was normal and in one patient the tissue was used only for culture. The results of the biopsy led to a beneficial change in treatment in two patients but did not influence management in the other patients. Conclusions: A leptomeningeal and brain biopsy was of limited practical value in diagnosis and management in most patients with chronic meningitis.     

Neurocysticercosis — A review of 231 cases

Summary Two hundred thirty-one cases of neurocysticercosis are reviewed. Diagnosis was established by cerebral computed tomography during a seven-year period (1983–1989). One hundred and fourty-four (62%) presented with symptom-related disease (symptomatic neurocysticercosis and in 87 the diagnosis was incidental (asymptomatic neurocysticercosis). In symptomatic neurocysticercosis the parasitosis was considered inactive in 115 cases and active in 29. Seizures occurred in 135 patients (96% of the symptomatic neurocysticercosis). In the active form we also found: meningitis (n=15), intracranial hypertension (n=12), hydrocephalus (n=10) and arteritis (n=2). Treatment included praziquantel (n=21), albendazol (n=4), dexamethasone (n=18) and surgery (n=10).

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Neurozystizerkose — Übersicht über 231 Fälle

Zusammenfassung Im Zeitraum von sieben Jahren (1983–1989) wurden mittels Computertomographie des ZNS 231 Fälle von Neurozystizerkose gesichert. In 144 Fällen (62%) handelte es sich um symptomatische, in 87 Fällen um asymptomatische Formen, die zufällig entdeckt wurden. In 115 der symptomatischen Fälle wurde die Parasitose als inaktiv und in 29 als aktiv beurteilt. 135 Patienten, das heißt 96% der Kranken mit symptomatischer Neurozystizerkose, litten an Anfällen. Aktive Formen wurden außerdem in 15 Fällen als Meningitis, in 12 mit intrakranieller Hypertension, 10 mit Hydrozephalus und zwei mit Arteriitis manifest. Therapeutisch wurde in 21 Fällen Praziquantel, in vier Fällen Albendazol, in 18 Fällen Dexamethason eingesetzt, und 10 Patienten wurden operiert.

     

Severe Cysticercal Meningitis: Clinical and Imaging Characteristics

In disease-endemic areas, severe cysticercal meningitis (SCM) is characterized by intense inflammatory cerebrospinal fluid (CSF) and negative bacterial and fungal cultures. There have been no systematic studies of SCM. We characterized patients with SCM and compare them with neurocysticercosis (NC) patients with mild CSF abnormalities by conducting a nine-year retrospective review at a neurological referral center. Two groups of patients were compared: group A, those with severe CSF pleocytosis > 1,000 cells/mm³ (n = 12), and group B, those with CSF pleocytosis ≤ 1,000 cells/mm³ (n = 126). All patients had positive CSF results in an enzyme-linked immunosorbent assay for cysticercal antigens and negative CSF cultures for bacteria, fungi, and mycobacteria. Intracranial hypertension, meningeal signs, CSF hypoglycorrachia, and a longer clinical course of NC were more frequently seen in group A. It is likely that SCM often goes unrecognized. Its correct identification may reduce morbidity and risks of unnecessary surgery in patients with chronic NC and CSF shunts.     

Hypopituitarism caused by neurocysticercosis

Although neurocysticercosis is pleomorphic in its presentation, neurocysticercosis of the pituitary gland and hypothalamus is so uncommon that less than 10 cases have been reported in the literature. Hypopituitarism as a complication of neurocysticercosis is exceedingly rare with only 2 cases described in the literature. Herein, the authors describe a case of neurocysticercosis causing hypopituitarism in a young patient and mimicking a pituitary adenoma. Clinical experience with management of these cases is lacking, and there are no studies confirming the efficacy of cysticidal drugs in intrasellar or suprasellar cysts. Because most of single enhancing cystic lesions may disappear spontaneously and risk may outweigh the benefit of treatment, conservative management may be indicated in these cases.     

Case Report: Five Cases of Recurrent Meningitis Associated with Chronic Strongyloidiasis

Although meningitis secondary to chronic strongyloidiasis is a rare complication, it is associated with a high mortality rate. Recurrent meningitis can occur if the underlying parasitic infection is left untreated. We report five cases of recurrent meningitis related to chronic strongyloidiasis that were associated with human T-lymphotropic virus type 1 (HTLV-1) infection. Common causative organisms are Escherichia coli, Streptococcus bovis, and Klebsiella pneumonia. One patient died during the second episode of meningitis. Three patients showed significant gastrointestinal and respiratory symptoms before developing headache and fever. In four cases, patients developed multiple recurrences even with the treatment of thiabendazol. Ivermectin seems to be a better agent compared with thiabendazol to achieve eradication of strongyloidiasis.     

Cryptococcal meningitis associated with chronic lymphocytic leukemia: a case report. Review of the literature

INTRODUCTION: The authors report the occurrence of a cryptococcal meningitis in a patient treated by corticosteroids and polychemotherapy for a chronic lymphocytic leukemia. EXEGESIS: A 63-year-old man with chronic lymphocytic leukemia was sent to hospital because of impaired condition with fever. Neurological disorders appeared. Cryptococcal meningitis was diagnosed. Under treatment, the outcome was favorable. CONCLUSION: This paper highlights the feature of this infection most likely underestimated in HIV-seronegative patients and the need to a priori consider this diagnosis.     

Infections à entérovirus de l’adulte traité par rituximab : un nouveau cas de méningite et myofasciite chronique et revue de la littérature

IntroductionChronic enterovirus infections can occur in primary immunodeficiency with hypogammaglobulinemia. They usually associate meningitis and myofasciitis. Such infections have also been described in adults with rituximab-induced hypogammaglobulinemia.Case reportWe report the case of a 33-year-old woman who was given rituximab for immune thrombocytopenia and developed rituximab-induced hypogammaglobulinemia (IgG 4.4 g/L). One year after the last rituximab infusion, she developed lower limbs myofasciitis, followed two months later by a chronic lymphocytic meningitis. PCR in the serum and the cerebrospinal fluid at the time of the meningitis and the myofasciitis were positive to the same enterovirus (echovirus 11) while it was negative in the fascia biopsy. Under treatment with intravenous immunoglobulins, all symptoms and laboratory abnormalities improved and enterovirus PCR became negative.ConclusionWe report a case of chronic enterovirus infection associating meningitis and myofasciitis in an adult with rituximab-induced hypogammaglobulinemia. Outcome was favorable under treatment with intravenous immunoglobulins.     

Sarcoidosis-like reaction related to Propionibacterium acnes and immune restoration syndrome in HIV infection

Propionibacterium acnes is thought to be a potential triggering agent of sarcoidosis. We describe a woman who developed chronic meningitis with sarcoid-like multisystemic involvement under treatment for human immunodeficiency virus infection. P. acnes was isolated from cerebrospinal fluid. We assume that P. acnes might have triggered this sarcoid-like reaction with meningitis, as a consequence of an immune reconstitution.     

Reactivation of neurocysticercosis: case report.

A 37-year-old woman with a known history of longstanding neurocysticercosis presented with a three-day history of new onset headache. Several years prior to her current presentation, she had undergone cysticidal treatment and was assumed to be cured of active disease. Computed tomography and magnetic resonance imaging studies done three months prior to presentation showed multiple intracerebral calcified lesions consistent with resolved neurocysticercosis. Physical and laboratory findings were noncontributory. Imaging studies showed the same previously calcified lesions, but they were now surrounded by large amounts of edema. This case represents a unique report of reactivation of neurocysticercosis and raises interesting questions about the natural history of this infection.     

Neurocysticercosis

Since international travel has become widespread, clinicians increasingly have been confronted with the diagnosis of symptomatic and incidental neurocysticercosis. The difficulty with managing this disease lies in its varied clinical presentations. The treatment of neurocysticercosis depends upon anatomic locations, stages of cysts, and overall cyst burden. Despite recent clinical and laboratory advances, experts are divided on many key management questions. This article reviews the pathophysiology and experimental data underlying treatment recommendations for this emerging and complex condition.     

Diagnostic des méningites chroniques

Chronic meningitis is defined by the association of symptoms of more than 1 month duration and an abnormal cellularity of the cerebrospinal fluid. About 10% of all meningitis are chronic meningitis. The differential diagnosis is wide and relies on anamnestic data, daily life characteristics and activities, immune status, clinical presentation and signs, and systematic search of most frequent causes. The main causes of chronic meningitis are tuberculous, cryptococcal, mainly in immunosuppressed patients, carcinomatous and systemic diseases associated meningitis. The first part of the paper details the overall etiological strategy to be used in the diagnosis of chronic meningitis. The second part is a literature-based review of the common and rare causes of chronic meningitis.     

Aseptic meningitis in adult onset Still’s disease

Adult onset Still??s disease (AOSD) is a systemic inflammatory disease characterized by high-fevers, articular involvement, maculopapular rash, hepatosplenomegaly, lymphadenopathy, and a neutrophilic leukocytosis. Though systemic complications of AOSD or its treatment are well described in the literature, CNS involvement in AOSD is exceedingly rare and can have protean manifestations. We present a patient with AOSD who developed chronic meningitis and sensorineural hearing loss on treatment, with a review of prior reported cases of aseptic meningitis, to highlight this rare complication of this uncommon illness.