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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighteen patients with cryptococcal infection of the central nervous system seen during a 10-year period were reviewed. Eleven patients (61 per cent) were immunocompromised due to underlying disease and seven of these were on steroids, cyclophosphamide or both. Two-thirds of patients presented with the triad of fever, headache and neck rigidity suggesting meningitis; seizures and mental confusion were uncommon. A high index of suspicion was essential for diagnosis particularly in immunocompromised subjects, and the diagnosis was established by positive Indian-ink preparation, culture or raised antigen titre in the cerebrospinal fluid. CT scan was helpful for diagnosis and progress monitoring. Amphotericin B and 5-fluorocytosine were the mainstay of treatment, and imidazole derivatives and garlic may be helpful adjuncts. Mortality was 39 per cent, but full recovery was the usual outcome in those who survived. The prognosis was worse with immunocompromised patients, and of those who died, comma and/or convulsion on admission and marked cerebral oedema and hydrocephalus on CT were notable features.
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PMID:Cryptococcal infection of the nervous system. 317 24

We gave some considerations to the significance of cyst formation in a case of cryptococcus meningitis by examining the cysts themselves and comparing the organisms in the cysts with those disseminated throughout the subarachnoid space by light and electron microscopy. An 18-year-old girl had complained of headache, stiffneck and fever at the onset. These symptoms worsened into confusion without any definite diagnosis, then resulted in an arrest of spontaneous respiration which led to use of respirator for 12 days. The patient died 40 days after the onset. The brain weighed 1440 g and showed moderate swelling with opacity of the leptomeninges, which was very evident over the convexity and around the basal side of the pons. Subarachnoid fresh hemorrhage was also observed around the basal side of the brain stem. Microscopic examination of the subarachnoid space revealed widely disseminated Cryptococcus neoformans varied in size, whose cell wall showed a positive staining reaction to PAS. The organisms had characteristic spicules positively stained with cresyl violet radiating out of the cell body, and were associated with infiltration of lymphocytes, macrophages and polymorphonuclear leukocytes throughout the subarachnoid space. Some portions of arachnoid membrane, dura mater and vessel walls in the subarachnoid space especially the adventitia of the basilar artery were replaced by multiple cysts. The cysts were tightly filled with large numbers of small uniformly sized organisms which often showed budding. These cysts showed no histological evidence for inflammation. Further studies to demonstrate those differences were carried out with electron microscopy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Light and electron microscopic observations of cysts in the brain from an autopsy case of cryptococcus meningitis]. 332 15

A rare case of adult group B streptococcal meningitis is presented. The association with diabetes mellitus is emphasized and attention is drawn to microscopic and serological confusion that may arise in differentiating it from pneumococcal meningitis.
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PMID:Group B streptococcal meningitis in a diabetic adult. 353 43

A 23-year-old woman with systemic lupus erythematosus had a severe hypersensitivity reaction to the drug ibuprofen. The reaction, documented by rechallenge during hospitalization, was characterized by marked hypotension, fever, rigors, conjunctivitis, meningitis, nausea, arthralgias, and leukopenia. In addition to illustrating the potential diagnostic confusion with infection or lupus flare, this case is of interest in that the reaction developed suddenly despite the patient's uneventful use of the drug for over two years. Collected cases are reviewed from the literature, and the common features are summarized.
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PMID:Severe systemic hypersensitivity reaction to ibuprofen occurring after prolonged therapy. 356 35

Two patients with cryptococcal intracerebral disease showed CT evidence of multiple round hypodense nonenhancing lesions in the gray matter. These lesions proved to be gelatinous pseudocysts rather than granulomas or abscesses. Pseudocysts may occur alone or with meningitis or granulomas. Recognition of these will avoid confusion with other infectious, vascular, or neoplastic conditions.
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PMID:Cryptococcal intracerebral mass lesions: CT-pathologic considerations. 399 Sep 73

The records of 16 consecutive patients with proven cryptococcosis, admitted to the two referral hospitals in Harare over a 15-year period, were reviewed. 15 were cases of meningitis, one with spinal cord granuloma, and the 16th was an orbital osteomyelitis. There were eight children and eight adults with a marked male preponderance. There was an absence of any predisposing conditions. The common clinical signs and symptoms were headache, neck stiffness, fever, confusion or drowsiness, cranial nerve lesions and long tract signs. The diagnosis was rarely suspected on admission but was discovered during life in 15 patients, in 12 by finding the organism in the (CSF) cerebrospinal fluid, and in three by biopsy of affected tissue. 50% of patients presented with a predominance of polymorphs in the CSF. The mortality rate was very high (57%) but most died before adequate treatment could be given.
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PMID:Cryptococcosis in Zimbabwe. 399 44

A review of the literature on primary diffuse meningeal gliomatosis (DMG) yielded three cases and we report a fourth. DMG is a syndrome characterized by extensive basal and spinal chronic meningitis with mental confusion, headaches, diplopia, papilledema and cranial nerve palsies. The cerebrospinal fluid (CSF) has a markedly elevated protein content, moderate mononuclear pleocytosis and a normal or low glucose. This picture invariably leads to the diagnosis and treatment of tuberculous or fungal meningitis despite persistently negative cerebrospinal fluid (CSF) cultures. Reaction of exfoliated CSF cells with glial fibrillary acidic protein (GFAP) immunoperoxidase labelled antibody is suggested as a diagnostic tool. A basal meningeal biopsy appears to be the only alternative diagnostic approach.
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PMID:Primary diffuse leptomeningeal gliomatosis. 405 90

Two infants, one premature and one full-term, died from meningitis due to Flav. meningosepticum type F. Careful bacteriological studies are required to prevent possible confusion with other Gram-negative bacilli which may cause meningitis in this age group.
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PMID:Neonatal meningitis caused by Flavobacterium meningosepticum type F. 590 87

A 72-year-old woman, previously in good health, suffered for 2 years from attacks of a complex neuropsychiatric syndrome lasting from 2 days to 4 weeks. These episodes, which were followed by intervals of nearly complete recovery, were usually marked by fever, headache, mental confusion, vomiting ataxia, anisocoria, epileptic seizures and stiffness of the neck. Neuroradiological investigation revealed only slight ventricular dilatation. In 13 CSF examinations, there was reduced glucose, increased protein, considerable rise of the IgG index and constant oligoclonal bands. There was also an increase of polymorphonuclear leucocytes, lymphocytes or epithelial-like cells. As all microbial, viral or mycotic tests were negative and the patient recovered, the case was considered to be benign recurrent meningitis of Mollaret. The nosological position of this rare disease, as well as its probable pathogenetic mechanisms, are discussed.
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PMID:A case of benign recurrent meningitis of Mollaret. 616 85

We interviewed and neurologically reexamined 94 patients who had previous pneumococcal meningitis. The findings were allocated into groups with and without a causal relationship to the meningitis. The main sequelae after meningitis were dizziness (23%), tiredness (22%), mild memory deficits (21%), and gait ataxia (18%), whereas other focal neurologic signs were rare. By a rating (0 to 5) of the presence and severity of sequelae after meningitis, 54% of the patients were found to have sequelae. The clinical condition at the time of acute illness was studied in subgroups of patients who had different neurologic sequelae or high sequelae ratings. Gait ataxia was associated with a state of agitation and confusion when the patient was admitted for meningitis. High sequelae ratings on reexamination were associated with an affected consciousness at the acute stage of the disease and with high numbers of WBCs in the CSF at the time of hospitalization.
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PMID:Pneumococcal meningitis. Late neurologic sequelae and features of prognostic impact. 647 11


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