Epidemic meningococcal meningitis in adult Ethiopians in Addis Abeba, Ethiopia, 1988.

278 patients with pyogenic meningitis admitted to the Tikur Anbessa Teaching Hospital in Addis Abeba, Ethiopia, between January and December 1988 were studied prospectively to describe the epidemiology, microbiology, clinical features and outcome of infection. Fifty-nine per cent of the patients were admitted in the hot dry season between January and the end of June. About half of the patients (57%) were in the age group 15 to 19 years; the male to female ratio was 1.8:1. Two hundred sixty-two specimens (94%) were examined by Gram stain/or culture. N. Meningitidis was cultured from 161 of 243 CSF specimens (65%) and the Gram stain was diagnostic in 108 of 140 CSF specimens (77%). Both Gram stain and culture were negative in 90 of 262 specimens (34%). Thirty-five of the isolates were sero-grouped and all were found to belong to serogroup A. All 30 isolates tested for drug sensitivity were resistant to sulfadiazine but sensitive to penicillin. Forty-three of 204 patients died of their infection, a case fatality rate of 21%: 60% of the deaths occurred in the first 24 hours after admission. Eleven of 13 patients with meningococcaemia expired. The case fatality rates for meningitis and meningococcaemia were 16% and 85% respectively. Nine patients (4%) developed neurologic sequelae: 4 hemiplegia, 3 nerve deafness, 2 cranial nerve palsies. This high morbidity and mortality from meningococcal infection demonstrates the need for a national surveillance programme for the prevention and control of meningococcal disease in the country.     

Formulation of meningococcal capsular polysaccharide vaccine-loaded microparticles with robust innate immune recognition

Neisseria meningitidis is a leading cause of bacterial meningitis and sepsis associated with a high mortality rate. Capsular polysaccharides (CPSs) are a major virulence factor and form the basis for serogroup designation and protective vaccines. The current polysaccharide meningococcal vaccines are available but are very expensive and require chemical conjugation. Here, we report a novel meningococcal vaccine formulation consisting of meningococcal CPS polymers encapsulated in albumin-based biodegradable microparticles that slowly release antigen and induce robust innate immune responses. Vaccines that elicit innate immunity are reported to have enhanced and protective adaptive immune responses. In this study, the meningococcal CPS-loaded microparticles, but not the empty microparticles, induced the release of IL-8, TNF-α and IL-1β, enhanced phagocytic capacity and induced robust autophagy in macrophages. The novel meningococcal vaccine microparticles are robustly taken up by macrophages and elicit strong innate immune responses that enhance antigen presentation which is a prerequisite for inducing adaptive immunity.     

Tympanic membrane penetrating trauma with CSF leak leading to pneumococcal meningitis in an infant

We report the case of an eighteen-month-old child who suffered a tympanic membrane perforation caused by a digital thermometer. This injury led to a CSF leak. The patient was followed conservatively with no surgical intervention or prophylactic antibiotic therapy and developed pneumococcal meningitis 7 days later. He was then treated with Ceftriaxone for 12 days with full recovery, from a short and long term perspective. Issues concerning the management of CSF leak will be discussed along with review of the literature. This is the first report of post-traumatic meningitis as a result of mild trauma not involving maxillofacial or basilar fractures. The aim of our report is to raise awareness to this cause of meningitis and to stress the importance of immunizing against Streptococcal pneumoniae, a measure which may have prevented the sequelae in our case.     

Prevention of secondary cases of meningococcal disease in household contacts by vaccination.

Household contacts of patients with group A meningococcal infection were vaccinated with either meningococcal vaccine or tetanus toxoid. Five of the 523 subjects who received tetanus toxoid developed meningococcal meningitis and another four probably had meningococcal disease. Only one possible case of meningococcal infection occurred among 520 contacts vaccinated with meningococcal vaccine. Vaccination had no effect on nasopharyngeal carriage of meningococci. Vaccination of household contacts of patients with group A meningococcal infections is an effective way of using limited supplies of meningococcal vaccine, though its value would be limited in an epidemic. Secondary cases of meningococcal infection often occur within a few days of the index case, and, although vaccine alone seemed to provide adequate prophylaxis in these Nigerian subjects, additional chemoprophylaxis may be needed to cover this critical period.     

Postoperative meningitis due to a rare pathogen; Alcaligenes xylosoxidans

Alcaligenes xylosoxidans is non-fermenting gram-negative bacilli found in soil and water. It is an aerobic bacterium in the genus Achromobacter. This bacterium is motile, oxidase positive, and catalase positive, which is isolated uncommonly from clinical specimens. In the present paper, we report a case of meningitis associated with A. xylosoxidans in a 38-year-old male patient post neurosurgery.     

Bacterial meningitis associated with infliximab

We report an episode of bacterial meningitis in a 45 year-old woman, who was treated with infliximab for Wegener’s granulomatosis. This patient presented with the classic clinical presentation of acute meningitis: the triad of fever, neck stiffness, and an altered mental state that appeared 6 months after the infliximab initiation. A computed tomographic (CT) scan of the head showed cerebral edema and Streptococcus peumoniae was isolated from blood and CSF cultures. Prompt diagnosis and early treatment improved the outcome of this patient.     

Unusual cause of fatal anthrax meningitis

We report the case of fatal anthrax meningoencephalitis in the province of Mu? located in eastern Anatolia, Turkey. The organism isolated from cerebrospinal fluid was identified as Bacillus anthracis. The patient was treated with crystallized penicillin G (24 MU/day IV) and ciprofloxacin (2?×?400/day IV), but died 5 days after hospitalization. Although it is a rare case, we consider that the patients who have skin, respiratory and neurological systems might also have hemorrhagic meningitis.     

组织细胞性坏死性淋巴结炎合并无菌性脑膜炎 1例并文献回顾

目的探讨组织细胞性坏死性淋巴结炎(菊池病)合并无菌性脑膜炎病人的临床特点。方法回顾分析 2022年 6月 10日南京市第二医院收治的 1例以发热、头痛、呕吐为首发临床表现的菊池病病人的临床资料。结果该病人不明原因高热,头痛、呕吐,颈部淋巴结多发肿大,外院结核感染 T细胞斑点试验为阳性,怀疑为结核性脑膜炎转入该院,入院后血清学、脑脊液化验无结核感染依据,予经验性抗病毒、抗感染、降颅压治疗后未见好转,后经颈部淋巴结穿刺活检病理检查明确诊断为菊池病,予糖皮质激素口服后体温降至正常,头痛症状缓解,随访了解到病人颈部肿大淋巴结缩小,未有复发。结论菊池病合并无菌性脑膜炎临床上有些医生认知不足,容易误诊误治,对于有发热、颈部淋巴结肿大伴有无菌性脑膜炎表现的病人要注意考虑菊池病可能,尽早行淋巴结穿刺活检可及早明确诊断。     

Meningococcal disease and meningitis: a review of deaths proceeding to coroner directed autopsy in Auckland.

AIMS: To assist the early diagnosis of meningitis, by finding trends and patient profiles, where delay or other factors may have lead to a fatal outcome. METHODS: All deaths from meningitis and meningococcal disease, confirmed at autopsy were reviewed. The study involved the Auckland area, in the period January 1988 November 1997. RESULTS: Cases were divided into those caused by N meningitidis and other meningitides. Death due to N meningitidis is often within 12-24 hours of the first symptomatology. Symptoms are often vague and may be indistinguishable from any other infection, often leading to fatal patient or doctor delay. A diagnosis of meningococcal disease cannot be excluded on: no rash (44%), no "meningitis" symptoms as sepsis without meningitis occurs (44%), age (50% were over 15 years old) or the presence of other abnormalities, eg bronchopneumonia or hydrocephalus. Non-N meningitidis menigitis is a disease of the very young or old, its time course is also swift with 30% suffering similar vague symptoms for less than 24 hours before death. CONCLUSIONS: For both categories, treat immediately and treat on suspicion, otherwise conformation of the diagnosis might be postmortem.     

Sensorineural hearing loss in children with epidemic meningococcal meningitis at Tikur Anbessa Hospital

There are several reports on epidemic meningococcal meningitis in some areas of Ethiopia, which lie in the meningococcal meningitis belt of Africa. Very little is known about the neurological sequel of epidemic meningococcal meningitis, especially that of hearing loss. This hospital-based study was conducted prospectively at the Ear Nose Throat clinic of the Pediatric Outpatient Department of the Tikur Anbessa Hospital during the meningococcal meningitis epidemic from May to October 2000 in order to assess the hearing status of patients after completion of their course of treatment. Demographic, clinical, microbiologic, audiometric data were collected using a preformed questionnaire. One hundred forty one cases of pyogenic meningitis were examined at discharge and on subsequent visits. Most of the patients (73.5%) were between 5 and 12 years of age. The major bacteriological isolate from the cerebrospinal fluid in 48 cases (35.3%) of the specimens was meningococci. Hearing loss was the commonest neurological sequel at discharge constituting 25% of the cases. At least 12.5% of the patients had severe to profound sensorineural hearing loss. This level of hearing loss would affect communication abilities and impair studies in school if left without rehabilitative measures including hearing aids or other means. Large scale community based studies are required to determine the magnitude of hearing loss associated with epidemic meningococcal meningitis.     

Acute encephalopathy associated with continuous vincristine sulfate combination therapy: case report

Summary Neurotoxicity is a well-recognized and commonly observed side effect associated with the use of vincristine sulfate in cancer chemotherapy. The clinical manifestations of vincristine neuropathy cover a wide spectrum of peripheral neurologic dysfunctions that have been described to be reversible and cumulative in most instances (1, 2). Paresthesias, loss of tendon reflexes, and progressive weakness are the most common clinical features (3, 4). Sensory impairment, cranial nerve palsies, gastrointestinal disturbances, and autonomie dysfunctions including atonic bladder, impotence, and orthostatic hypotension may occur (5). Acute CNS complications, usually presenting as generalized seizures, are extremely rare and only a few cases have been reported which were without underlying biochemical or structural abnormalities (1, 5–9). We describe the case of a woman with multiple myeloma, who developed fulminant encephalopathy following 4 days of continuous vincristine, adriamycin, and day 1–4 pulse dexamethasone (VAD) combination therapy.     

Serogroup B meningococcal vaccines

Neisseria meningitidis causes severe, often fatal septicemia and meningitis. Polysaccharide vaccines that offer protection against infection with meningococcal serogroups A, C, Y and W-135 are effective in older children and adults, and have been widely used. New polysaccharide-conjugate vaccines against one or more of these serogroups are now in use or under accelerated development; however, a broadly protective vaccine against infection by serogroup B N meningitidis is not yet available. Serogroup B contributes significantly to the burden of meningococcal disease in many industrialized countries where both epidemic and endemic serogroup B infections occur. Vaccines effective against specific strains responsible for serogroup B epidemic disease have been developed, but the development of a safe serogroup B vaccine that is cross protective against multiple strains and is effective in infants and young children is a challenge. In spite of these difficulties, promising approaches stemming from a better understanding of meningococcal pathogenesis and of the genetics of serogroup B N meningitidis continue to evolve. Progress toward an effective serogroup B vaccine, an important addition for meningococcal disease prevention, is the focus of this review. The epidemiology and pathogenesis of meningococcal disease are detailed, along with discussion of the challenges faced in the development of efficacious serogroup B vaccines.     

Meningococcal vaccine against serogroups A, C, Y and W-135: new preparation. Encouraging immunogenicity studies

(1) Prevention of meningococcal meningitis is based on vaccination, and chemoprophylaxis in case contacts. The five main meningococcal serogroups known to be pathogenic for humans are A, B, C, Y and W-135. Their geographic distribution is variable. In France, two-thirds of cases are due to serogroup B, which is poorly immunogenic and for which there is no vaccine; the only licensed vaccine offers protection solely against serogroups A and C. (2) A meningococcal polysaccharide vaccine directed against serogroups A, C, Y and W-135 has been granted temporary authorization for use by pilgrims to Mecca and for case contacts. (3) The vaccine elicits antibodies against the four serogroups in most adults, at least in the short term. It is poorly immunogenic in children under two years of age, especially against serogroup C. (4) The preventive efficacy of the vaccine against meningitis due to serogroups Y and W-135 is not known, and few data are available on serogroups A and C. Protection has not been shown beyond two years after vaccination. At one year the vaccine provides about 95% protection against serogroup A and 65% against serogroup C. (5) Systemic and local reactions to vaccination with the four-valent vaccine appear to be acceptable. (6) In practice, for want of anything better, the four valent vaccine (A, C, Y and W-135) is better than the two-valent vaccine (A+C) for protecting pilgrims to Mecca and contacts of patients with serogroup A, C, Y or W-135 meningococcal infection.     

Treatment of Nelson's syndrome by pituitary implantation of yttrium-90 or gold-198.

Eight patients with Nelson's syndrome were treated with a pituitary implant of yttrium-90 or gold-198 four to 16 years after adrenal surgery. All had considerable pigmentation. One already had cranial nerve abnormalities and visual field defects and had had both a craniotomy and deep x-ray treatment. Radiographs showed that the pituitary fossa was abnormal in seven patients. A biopsy performed in six cases showed mucoid (or basophil) adenoma in all. In the four specimens examined ACTH was identified by electron microscopy or immunofluorescence, or both. Patients were followed up after pituitary implantation for three months to 12 years. All showed decreased pigmentation, and six became normal. Four patients regained normal ACTH levels and the other two studied had decreased levels. In no case did new cranial nerve disease or further sellar expansion develop since operation, and two patients showed remodelling of the sella. Complications were temporary leakage of cerebrospinal fluid and diabetes insipidus in one patient and gonadotrophin deficiency in another.     

Do corticosteroids improve outcome in meningitis?

Despite significant advances in prevention of meningitis through vaccination, and in improved antimicrobial treatment, the disease still kills around 340,000 people worldwide each year.1 Around 75% of these deaths occur in Africa and South East Asia and around 3% in Europe.1 The mortality rate for bacterial meningitis is 10-30% and sequelae, such as cranial nerve impairment, particularly leading to hearing loss, occur in 5-40% of patients.2 Whether adjunctive corticosteroid treatment improves the outcome in bacterial meningitis through an anti-inflammatory effect has been a long-standing controversy. Here we review the role of adjunctive corticosteroids in the management of children (aged over 1 month) and adults with bacterial or tuberculous meningitis.     

New therapies and vaccines for bacterial meningitis

Acute bacterial meningitis remains an important cause of morbidity and mortality worldwide. There have recently been major advances in the prevention of the major causes of bacterial meningitis following improvements in vaccinology. The success of immunisation against Haemophilus influenzae type b infection is being mirrored with serogroup C conjugated meningococcal vaccine and pneumococcal conjugate vaccine. However, there remain major challenges, notably, serogroup B meningococcal infection and shifts in epidemiology caused by vaccine introduction. In addition, much of the world’s population is unvaccinated. Therefore, improvements in management of acute bacterial meningitis are vital. In this review we attempt to summarise important advances in both prevention and treatment of acute bacterial meningitis.     

New therapies and vaccines for bacterial meningitis

Acute bacterial meningitis remains an important cause of morbidity and mortality worldwide. There have recently been major advances in the prevention of the major causes of bacterial meningitis following improvements in vaccinology. The success of immunisation against Haemophilus influenzae type b infection is being mirrored with serogroup C conjugated meningococcal vaccine and pneumococcal conjugate vaccine. However, there remain major challenges, notably, serogroup B meningococcal infection and shifts in epidemiology caused by vaccine introduction. In addition, much of the world's population is unvaccinated. Therefore, improvements in management of acute bacterial meningitis are vital. In this review we attempt to summarise important advances in both prevention and treatment of acute bacterial meningitis.     

Vestibular nerve activation of a brain stem cholinergic system influencing the spinal cord

In precollicular decerebrate cats the modification of effects of VIIth nerve stimulation on the spinal cord by physostigmine and atropine was studied.

1.

1. Repetitive stimulation of the VIIIth cranial nerve produces 2 phenomena in the lumbar cord: dorsal root potential and tension in extensor muscles, associated with facilitation of the corresponding monosynaptic reflex.