First case of herpetic meningoencephalitis treated with ganciclovir

Consensus treatment for herpetic meningoencephalitis is intravenous aciclovir but no guidelines are available for alternative treatment in case of renal failure induced by aciclovir. We report to the best of our knowledge, the first case of herpetic meningoencephalitis treated with success by ganciclovir.     

Clinical Characteristics of Streptococcus Pneumoniae Meningoencephalitis after Transsphenoidal Surgery: Three Case Reports

We report three extremely rare cases of Streptococcus pneumoniae meningoencephalitis (SPM) after transsphenoidal surgery (TSS). Between 2004 and 2010, we experienced three cases of severe SPM after surgery out of 1,965 patients undergoing TSS (0.15%). The three cases included a 4-year-old boy with a large cystic craniopharyngioma, a 40-year-old man with a non-functioning pituitary adenoma, and a 55-year-old man with acromegaly. The similarity among these SPM patients was that severe clinical events occurred suddenly 1–2 months postoperatively without any history of sinusitis or pneumonia. Despite intensive care these patients notably had residual neurological sequelae. In no case was rhinorrhea associated with SPM. It should be noted that SPM was not detected from bacterial cultures of the sphenoidal sinus mucous membranes (BCSM) obtained during TSS in two of the patients examined. Severe postoperative SPM can occur suddenly without cerebrospinal fluid (CSF) leakage within 2 months after surgery and requires emergency treatment. Reduced resistance to infection may play a role in the occurrence of SPM in our three patients. Our study indicates that BCSM is not useful for predicting postoperative meningitis.     

细胞因子在腮腺炎并脑膜炎患儿发病中的作用和变化

目的 探讨细胞因子在腮脑患儿发病中的作用和变化情况，及急性期静脉丙球治疗后的变化。方法 采用双抗体夹心法测定腮脑患儿血清中细胞因子水平及丙球治疗后的变化。结果 腮脑患儿血清中细胞因子均有不同程度的升高。治疗后细胞因子水平均降低。结论 腮脑发病与细胞因子存在相关性。静脉丙球是有效的治疗措施之一。     

热灭活隐球菌对小鼠隐球菌脑炎的作用及其机制

目的：研究脑内接种热灭活的隐球菌(heat—inactived Cryptococcus neoformans,H-CN)在中枢神经系统隐球菌感染中的作用及对小鼠脑和脾IL—2、IL—6基因表达的影响。方法：实验动物随机分为实验组(先给予两次脑内接种H—CN)和对照组(先给予两次脑内接种生理盐水)，然后分别取两组中部分小鼠的脑和脾用RT—PCR方法检测IL—6mRNA和IL—2mRNA基因表达，同时给予两组剩余小鼠脑内接种致死量的隐球菌，观察小鼠脑组织病理改变。结果：小鼠脑组织总RNA以IL—6和IL—2引物进行RT—PCR，实验组IL—6表达阳性，IL—2表达阴性，对照组IL—6、IL—2均表达阴性。小鼠脾组织总RNA以IL—6和IL—2两种引物进行RT—PCR，两组IL—6、IL—2均表达阴性。实验组小鼠脑组织病理与对照组相比可见侧脑室的隐球菌周围有大量的炎性细胞浸润。结论：脑内接种H—CN可引起中枢神经系统特异性免疫反应，中枢神经系统抗隐球菌机制很可能与H—CN引起局部细胞因子IL—6的分泌有关。     

聚合酶链反应诊断新型隐球菌脑膜脑炎50例

目的 探讨聚合酶链反(PCR) 新型隐球菌脑膜脑炎快速诊断的临床标准。方法 应用聚合酶链反应检测50例临床脑脊液标本中的新型隐球菌，同时用直接涂片墨汁复杂、真菌培养进行对比检测。结果 在50例患者临床脑脊液标本中，PCR检测阳性11例；直接涂片墨汁复染阳性7例阳性；真菌培养阳性9例。结论 用PCR方法具有简便、快速、特异、敏感的特点，从脑脊液标本中直接检测新型隐球菌，提供病原学诊断依据，对新型隐球菌脑膜脑炎的快速诊断具有重要的临床意义。     

Cryptococcal meningoencephalitis in a non immunocompromised patient: Case report with necropsy

We report a case of cryptococcal meningoencephalitis in a young woman with no debilitating disease and not on immunosuppressant therapy.

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Sommario Viene descritto un caso di meningoencefalite da criptococco in una giovane donna non affetta da patologie debilitanti né in trattamento con immunosoppressori.

     

Cerebral malaria caused by Plasmodium vivax in adult subjects

Cerebral malaria is a diffuse encephalopathy associated with seizures and status epilepticus which can occur in up to one-third of patients with severe malaria, particularly that caused by Plasmodium falciparum.In this article, we report three cases of Plasmodium vivax malaria (all adult male patients) complicated by seizures and symptoms of diffuse meningoencephalitis. Two patients had predominantly meningeal signs, while in the third patient the features were purely of encephalitis All cases were treated with artesunate. Usually, cerebral malaria is caused by P. falciparum, and rarely, cerebral malaria is a presenting complication or occurs during the course of P. vivax infection.     

Evaluation of haematological, serum biochemical and cerebrospinal fluid parameters in experimental bacterial meningoencephalitis in the dog

To evaluate the effects of bacterial meningoencephalitis on blood and cerebrospinal fluid (CSF) parameters, an experiment was conducted with eight Iranian crossbred dogs. Blood and CSF samples were collected once before the administration of bacteria for obtaining control values. Following the injection of Escherichia coli k₁₂ into the CSF from the atlantooccipital space, samples were collected, and clinical signs of meningoencephalitis were observed. Blood and CSF samples were obtained from the meningoencephalitis group at 2, 4 and 6 days post-infection. Following the induction of meningoencephalitis, the number of white blood cells and the percent and absolute number of neutrophils significantly increased (P<0.05). However, the percent and absolute numbers of lymphocyte and eosinophil significantly decreased (P<0.05). Moreover, the number of platelet, monocyte, red blood cells, haemoglobin, packed cell volume, mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration had no significant change (P>0.05). The concentrations of glucose and activities of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK) in serum significantly increased (P<0.05). Cell numbers and the concentrations of total protein, cholesterol and inorganic phosphorus and the activities of AST, alanine aminotransferase (ALT), LDH and CK in CSF increased significantly (P<0.05). In contrast, the concentration of glucose in CSF decreased significantly (P<0.05). Furthermore, the concentration of CSF calcium did not change significantly (P>0.05). This study showed that bacterial meningoencephalitis could have profound effects on blood and CSF parameters that enable robust diagnosis to be reached.