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Query: UMLS:C0004623 (bacterial infection)
 15,226 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial diseases of the central nervous system develop per continuitatem of haematogenically. Each of these two groups can further be subdivided. As an initial therapy when an unknown agent is present chloramphenicol in high doses (200 mg/kg KM) stood the test for adults and older children and ampicillin (200 to 400 mg/kg KM), respectively, for babies and infants. In case of need, this therapy is correlated according to the findings of the culture and the antibiogramme. In secondary meningitides the surgical cure of the focus should be performed only after improvement of the general condition. Recidivating meningitides undergo an operation when liquor fistulae are proved. In an unclarified cause a long-term therapy with oxacillin or lincomycin over 3-6 months is possible. In the meningitis of newborn the combination of ampicillin, carbenicillin or colistin with gentamycin is necessary, intravenously and intrathecally. Hydrocortisone and streptokinase shall prevent the transfer of the liquor spaces. Of great importance is the combat against the cerebral oedema. In mycetogenous meningitis amphotericin B, eventually in combination with 5-fluorocytosine, can be used. There are still no effective remedies against the amoebic meningo-encephalitis.
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PMID:[Schematic principles in the therapy of bacterial inflammation of the brain and meninges]. 702 80

Serum and ventricular fluid pharmacokinetic data for amikacin were evaluated prospectively in 10 hydrocephalic children with suspected ventriculitis. After the fourth or fifth intravenous 7.5-mg/kg dose of amikacin given every 8 h, mean peak serum levels were 24.3 +/- 3.2 microgram/ml (achieved at 0.5 h) with a calculated half-life of 2.2 +/- 1.1 h. Mean peak ventricular fluid levels in five patients with bacterial infection were 6.1 +/- 2.0 microgram/ml (achieved at 3 h). In the remaining five patients without bacterial ventriculitis, very low levels (less than or equal to 0.7 microgram/ml) of amikacin were detected. Ventricular fluid pleocytosis was directly correlated and glucose levels were inversely correlated with penetration of amikacin. Systemic therapy with amikacin may be the treatment of choice for children with ventriculitis meningitis caused by bacteria which are highly susceptible to this drug, thereby permitting the avoidance of the potentially hazardous intraventricular route of administration.
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PMID:Intraventricular levels of amikacin after intravenous administration. 732 26

The level of lactic acid in cerebrospinal fluid has been suggested as a useful diagnostic parameter to differentiate between bacterial and viral meningitis, especially in patients partially treated before admission to hospital. A concentration of greater than or equal to 35 mg/dl, determined by either gas-liquid chromatography or an enzymatic method, has been considered in several studies to provide definite evidence of meningitis of bacterial origin, whereas a lower level indicates no bacterial involvement. Over the past 18 months, we have analyzed by the enzymatic method the lactate level in 493 spinal fluids submitted from 434 adult patients with various conditions involving the central nervous system. Fifty fluids had a lactate level of greater than 35 mg/dl, of which 19 were cases of infective meningitis of varying etiology. The 435 specimens with lactate levels within the range considered normal included three cases of infective meningitis, of which two were cryptococcal and one was bacterial. In this adult study, the lactate level in the cerebrospinal fluid did not provide unequivocal evidence of bacterial infection and did not provide assistance to any greater degree than the standard parameters of leukocyte count, protein, and glucose contents in the differential diagnosis of bacterial meningitis from that of any other etiology.
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PMID:Evaluation of cerebrospinal fluid lactic acid levels as an aid in differential diagnosis of bacterial and viral meningitis in adults. 737 96

Infant rats were infected intranasally with wild influenza virus strains, attenuated strain A/Okuda/57 or recombinants prepared from these parents. The growth of viruses in the turbinates or lungs, and the ability of virus infections to potentiate subsequent bacterial infection by Haemophilus influenzae (HIb) were measured. The two wild strains of virus and a recombinant strain WRL105, known to be virulent for man, reached titres of 10(5.1)--10(6.5) EBID50/ml in the turbinates of infant rats 48 h after infections; infection by these viruses was followed by HIb bacteraemia in 77--92% and meningitis in 58--75% of animals. In contrast, virus strains known to be attenuated for man grew to lower titres in infant-rat turbinates and promoted a lower incidence of systemic infection by HIb than the virulent strains. A comparison of the various results of infection of infant rats with influenza virus strains of known pathogenicity for man indicated that the subsequent incidence of HIb bacteraemia was the most discriminating measurement of virus virulence; the range of yields of attenuated virus in rat turbinates overlapped that of virulent strains. These results, together with those of previous studies, indicate that the behaviour of influenza viruses in infant rats is an indication of virus virulence for man, and could provide a test of virulence that would facilitate the development of live attenuated virus vaccines for human use.
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PMID:Influenza virus infection of newborn rats: virulence of recombinant strains prepared from influenza virus strain A/Okuda/57. 738 17

We examined the value of serum C-reactive protein (CRP) in febrile children without an apparent focus of infection, (i) as a tool to differentiate bacteraemia and bacterial infection from a non-bacterial illness (NBI), and (ii) as an indicator of recovery or complications. Included in the study were 100 children up to the age of 3 years with a temperature of > or = 38.5 degrees C, without an apparent focus. The serum CRP concentration was measured on days 1, 3 and 5 of evaluation and correlated with the final diagnosis and outcome. The serum CRP was 40 mg/l and above in 95% of patients (18/19) with bacteraemia and also in seven of the eight with purulent meningitis, while it was < 40 mg/l in 84% of patients (52/62) with NBI (mean (SD) 22 (28.6) mg/l). The mean serum CRP concentration among six children with a culture-positive urinary tract infection (16.3 (8.3) mg/l) and five with otitis media (9 (5.7) mg/l) was similar to those with NBI. The sensitivity of serum CRP > or = 40 mg/l for diagnosis of bacteraemia was 95% and the positive predictive value 67%. On serial monitoring, a fall in the CRP concentration was a sensitive indicator of recovery from infection and provided the earliest clue to therapeutic response long before a fall in temperature.
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PMID:Value of serum C-reactive protein concentrations in febrile children without apparent focus. 750 86

We examined the measurement and the diagnostic value of cerebrospinal fluid interleukin-6 (CSF IL-6) in meningitis. The cytokine was measured by bioassay (B9 hybridoma cell line) and by immunoassay (in-house radioimmunoassay). We compared the diagnostic value of CSF IL-6 determination with that of other biochemical markers of meningitis. Although there was significant correlation between bioactive and immunoactive IL-6 (r = 0.724, P < 0.001), results were frequently different with biological/immunological ratios ranging from 0.2 to 24.3 (mean 4.6). Gel permeation chromatography suggested that the discrepancy in biological and immunological activities was not due to molecular heterogeneity, but may be explained by the presence of a synergistic factor. Interleukin-6 concentration was markedly elevated in CSF from most patients with bacterial meningitis compared to patients with viral meningitis and those without evidence of infection. However, low IL-6 levels by radioimmunoassay did not exclude bacterial meningitis (sensitivity 86%). CSF total protein and CSF glucose were significantly different between all three groups, but there was no significant difference in lactate concentration between virally infected and normal CSF, both of which had lower lactate concentrations than those in bacterial infection. CSF IL-6 measurement had greater sensitivity, specificity and predictive value than these other biochemical markers, and hence a rapid assay for IL-6 in CSF may contribute to the early diagnosis of bacterial infection.
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PMID:Cerebrospinal fluid interleukin-6 and its diagnostic value in the investigation of meningitis. 763 33

Haemophilus influenzae type b (Hib) is a major cause of serious bacterial infection in early childhood. In many developed countries it is the commonest cause of bacterial meningitis in children under 5 years of age. Serum antibodies to the polyribosylribitol phosphate (PRP) capsule, the main virulence factor of Hib, are protective, but the early vaccines containing purified PRP were poorly immunogenic in young children. However, 'second generation' protein conjugate vaccines have been shown to be immunogenic, effective and safe in young children. No serious adverse reactions to Hib vaccine have been reported to date. Clinically, the vaccine is indicated in the first few months of life and can be given at the same time as a primary course of diphtheria, pertussis and tetanus (DPT) immunisation. The vaccine should be given by deep subcutaneous or intramuscular injection. The only specific contraindication is a history of severe local reaction or a general reaction to previous Hib vaccination. Routine immunisation of infants under 6 months of age against Hib has become part of the regular primary schedule in many countries. In Finland this has resulted in a dramatic decline in Hib meningitis.
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PMID:Rational use of Haemophilus influenzae type b vaccine. 769 29

Autopsy or biopsy findings in 10 human immunodeficiency virus (HIV)-positive persons from Bangalore, India, revealed a wide spectrum of pathological changes. Patients' mean age was 33.4 years and the mean duration between symptom onset and death was 27.13 days. Nine patients had evidence of neuro-acquired immunodeficiency syndrome (AIDS) and 8 of them succumbed to various opportunistic infections. Histologic examination showed diffuse cryptococcal meningitis in 5 cases; 2 cases showed disseminated systemic cryptococcosis. Pulmonary tuberculosis was present in 3 patients. Despite no signs of associated neurotuberculosis in any patient, 4 autopsied and 1 biopsied case showed evidence of systemic tuberculosis. Toxoplasma encephalitis was present in 2 cases; observed in this series was the first case, in India, of co-existent toxoplasma and acanthamoeba. Other bacterial infections such as meningococcal meningitis and psudomonas septicemia were found in 3 cases; pneumocystis carinii pneumonia was present in 1 case. Evidence of early HIV leukoencephalopathy was observed in the only asymptomatic HIV-positive individual (who died in a traffic accident). AIDS-associated bacterial infections caused by organisms other than Mycobacterium tuberculosis are often underdiagnosed and should be considered in developing countries. In cases of cryptococcal and tuberculosis meningitis or multiple parasitic infections, patients should be screened for associated HIV infection.
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PMID:Pathological lesions in HIV positive patients. 775 Oct 41

Bacterial infections in neonates may be acquired in utero, as is the case in congenital syphilis, or after delivery, such as late onset B streptococcal meningitis. Although some infections remain localized and may even be self-limiting, the majority of neonatal bacterial infections require speedy diagnosis and immediate and appropriate treatment. Severe invasive bacterial infections are rare but catastrophic; they are more common in intensive care wards. Neonatal, maternal, and environmental factors favoring bacterial infections are discussed together with their main clinical features. Useful diagnostic parameters are examination of the placenta, leukocyte counting, erythrocyte sedimentation rate, and C-reactive protein. If a bacterial infection is suspected in a baby that is sick or in poor general condition (low birth weight, therapies, environmental conditions) a "septic therapeutic approach" must be adopted which includes examination and culture of blood, cerebrospinal fluid, and urine, as well as of any other suitable material according to clinical and laboratory findings. Pathogens most frequently involved in neonatal infections (streptococci, staphylococci, Listeria, gram-negative enteral bacteria) can be presumptively identified by comparatively simple laboratory tests. The valid interpretation of the results of these tests is dependent upon the degree to which the laboratory personnel is familiar with techniques of identification and assessment of sensitivity, as well as on the close cooperation between clinical department and laboratory from the start and all along the course of the disease.
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PMID:[Diagnostic possibility in neonatal bacterial infections]. 792 83

We present a systematic review of meningitis associated with transsphenoidal surgery. Patients present within the first 4 days after surgery with symptoms of headache, fever, and confusion. Overt cerebrospinal rhinorrhea or nuchal rigidity at the time of presentation is an infrequent finding. Although postoperative aseptic meningitis may be difficult to distinguish from early bacterial meningitis, the findings of hypoglycorrhachia, pleocytosis, and hyperproteinemia in the setting of fever and neurological deficit strongly suggest bacterial infection. The preponderance of cases of gram-negative meningitis observed in this series and in previous reports related to posttraumatic CSF leaks indicates that empirical regimens should include agents suitable for treating infections caused by nosocomial pathogens. In general, patients with uncomplicated meningitis in this setting can be expected to recover and do well. Questions remain as to the role of prophylactic antibiotics in the development of gram-negative meningitis in the setting of transsphenoidal surgery. A multicenter trial might be better able to define this role.
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PMID:Gram-negative meningitis associated with transsphenoidal surgery: case reports and review. 803 9


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