Post-operative meningitis caused by drug-resistant Streptococcus pneumoniae: two case reports

We report 2 patients with post-operative meningitis caused by drug-resistant Streptococcus pneumoniae (DRSP), following correction of frontoethmoidal encephalomeningocele in 1 patient and adenotonsillectomy in the other. Both patients responded well to vancomycin plus cefotaxime. DRSP may be colonized in the upper respiratory tract and causes serious infections after surgical operation.     

Immunization for persons infected with human immunodeficiency virus

Immunization is an important measure to protect HIV-infected children and adults against certain vaccine preventable diseases. However, the antibody response, which is associated with the level of CD4+ T cell count, is frequently impaired in this group of patients. Certain vaccines enhance virus replication and transiently increase HIV viral load. Theoretically, vaccination should be given before the immune status of the patients is suppressed. Inactivated vaccines are generally safe and are beneficial for HIV-infected patients. These vaccines should be administered at appropriate age recommended for immunocompetent individuals. Live vaccines should be used with caution since some of the vaccines may be harmful to patients with severe immunologic suppression. Recommendations for immunization in HIV-infected patients may differ from country to country, depending on the availability and affordability of each vaccine, and the prevalence of each preventable disease. Vaccine trial in HIV-infected patients is needed in order to establish the most appropriate vaccine recommendation for this group of patients.     

Pharmacological studies on Y-8894. (III). Its effect on the abnormal electrocorticogram induced by destruction of the internal capsule

The effect of Y-8894 on the abnormal electrocorticogram (ECoG) of alcuronium-immobilized rats, induced by destruction of the internal capsule with heat, was compared with that produced by imipramine, amantadine and Ca-hopantenate. ECoG power in the delta + theta (1-7 Hz), alpha (7.5-12.5 Hz) and beta (13-30 Hz) bands was used as an index. Delta + theta power increased following destruction of the internal capsule with heat. The increased delta + theta power (abnormal ECoG) lasted for 60 min following the injection of saline at 60 degrees C for 3 min. Y-8894 (0.1-1 mg/kg, i.v.) apparently improved the abnormal ECoG dose-dependently by significantly reducing the increased delta + theta power. Similar results were obtained with amantadine (10 mg/kg, i.v.), but its potency was weaker than that of Y-8894. Imipramine (1 mg/kg, i.v.) and Ca-hopantenate (30 mg/kg, i.v.), however, both failed to modify the abnormal ECoG. All drugs, except Ca-hopantenate, decreased the magnitudes of the alpha and beta bands. The above results suggest that Y-8894 may be effective in ameliorating cerebral dysfunction induced experimentally by the lesion of the internal capsule.     

Preventive strategies of perinatal HIV-1 transmission: an experience from Thailand

There are at least 6 million people in the Asia-Pacific region living with HIV/AIDS. The number of HIV-1 infected women and children is increasing. Important components in order to prevent perinatal HIV-1 transmission include counselling, HIV testing, family planning, obstetric care, antiretroviral agents and avoidance of breast feeding. Zidovudine or nevirapine used as monotherapy or in combination with other antiretroviral agents are recommended as a standard of care in the prevention of perinatal HIV-1 transmission. Each country needs to have its own data concerning HIV/AIDS epidemiology, and the infrastructure and resources to select appropriate strategies in reducing the perinatal HIV-1 transmission rate.     

Elevation of serum pro-gastrin-releasing peptide in patients with medullary thyroid carcinoma and small cell lung carcinoma.

Medullary thyroid carcinoma (MTC) arises from parafollicular or C cells of the thyroid gland and produces a variety of peptides such as calcitonin (CT) and gastrin-releasing peptide (GRP). Here we measured serum levels of pro-gastrin-releasing peptide (Pro-GRP), a more stable precursor of GRP, in 15 patients with MTC (4 males, 11 females) who did not show any clinical or radiologic signs of small cell lung cancer. Serum Pro-GRP levels were elevated in 80% (12/15) patients. Significant correlation was observed between serum Pro-GRP and CT (r = 0.52) and carcinoembryonic antigen (CEA) (r = 0.56). Serum Pro-GRP levels also correlated with tumor size (r = 0.70). Serum Pro-GRP levels also decreased below the cut-off range in one patient after surgical resection. Our data suggest that Pro-GRP, which is considered to be a specific marker for small cell lung carcinoma, seems to be also helpful and additional marker for the diagnosis and monitoring the response to therapy in patients with MTC in addition to calcitonin as the main tumor marker.     

Purpuric-like rash as cutaneous eruptions in parvovirus B19 infection in Thai infant

An 8-month-old girl presented with fever, rash, and diarrhea. Physical examination revealed multiple well-circumscribed, brownish-black, purpuric-like rashes on the face, arms, and legs with cervical and suboccipital lymphadenopathy. Laboratory findings showed mild anemia with thrombocytopenia and positive polymerase chain reaction for parvovirus 819 DNA in the serum. The patient recovered uneventfully with symptomatic and supportive treatment. Since the infection can manifest in many dermatological patterns, it should also be included in the differential diagnosis of febrile illness with purpuric rash in children.