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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

143 people treated for tick-borne encephalitis (TBE) were included in a retrospective follow-up study. Sequelae and epidemiological characteristics in 114 individuals were analysed. The case fatality rate and the prevalence of residual paresis were low, 1.4 and 2.7%, respectively. However, 40 (35.7%) individuals were found to have a postencephalitic syndrome after a median follow-up time of 47 months, and a majority (77.5%) of these were classified as moderate to severe. Various mental disorders, balance and co-ordination disorders and headache were the most frequently reported symptoms. Increasing age was correlated to a longer duration of hospital stay, longer convalescence and increased risk of permanent sequelae. Results from a neuropsychiatric questionnaire showed marked differences between the subjects with sequelae compared to controls. 57% had noticed a tick bite before admission, and 48% were aware of at least one person in their environment who previously had contracted TBE. 79% were permanent residents or visited endemic areas often and regularly. In conclusion, we have found that TBE in the Stockholm area has a low case fatality rate, but gives rise to a considerable number of different neurological and mental sequelae, which justifies vaccination of a defined risk population in endemic areas.
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PMID:A 10-year follow-up study of tick-borne encephalitis in the Stockholm area and a review of the literature: need for a vaccination strategy. 886 49

Herpes simplex virus (HSV) typically causes mucocutaneous disease, encephalitis, and acute men ingitis. There have been no previous reports of chronic meningitis due to this virus. A case of chronic meningitis due to herpes simplex virus type 2 (HSV-2) in a previously healthy 35-year-old woman whose predominant symptoms were headache and meningism without fever is described. Analysis of cerebrospinal fluid (CSF) revealed a lymphocytic pleocytosis, elevated protein, and hypoglycorrhachia. The diagnosis of herpes simplex meningitis was supported by the detection of HSV-2 DNA in CSF by polymerase chain reaction and by intrathecal production of HSV-specific antibody. The patient recovered after treatment with intravenous acyclovir and glucocorticoids.
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PMID:Chronic meningitis due to herpes simplex virus in an immunocompetent host. 889 73

A 37-year-old woman was admitted to the hospital on October 4, 1991 because of fever, headache, and abnormal behavior. Although she was treated with aciclovir, she developed encephalitis, which slowly manifested itself over the next month as meningeal irritation, loss of consciousness, partial seizure, and quadriparesis. Her cerebrospinal fluid showed mild lymphocytic pleocytosis without protein elevation. Serum IgG antibody titer to rubella virus was elevated, but the rubella virus could not be detected in the cerebrospinal fluid by PCR amplification. Her consciousness level improved slowly, and by the end of November she suffered only dystonic posture of her right arm and hand. By the middle of December, there were no abnormal neurological findings except some extrapyramidal tract signs and symptoms, such as tremor and rigidity. The serum rubella virus IgG titer had fallen back into the normal range. Her illness was diagnosed as subacute panencephalitis, and she recovered completely about 5 months after the onset of the disease. The lack of rubella virus in the cerebrospinal fluid suggests that panencephalitis may not be dependent on virus replication within the central nervous system. Specific T cells sensitized to proteolipid protein synthetic peptides (PLP158-166) identified with rubella virus were detected in this case during the active stage. These observations imply that subacute panencephalitis may be dependent on an immune-mediated mechanism and that PLP-specific T cells may play an important role in pathogenesis of the disease.
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PMID:[A case report of subacute panencephalitis associated with specific T cells sensitized to proteolipid protein (PLP) synthetic peptides identified with rubella virus]. 897 31

91 patients with trichinosis were treated at the Clinic of Infectious and Dermatovenereology Diseases in Novi Sad during a one-year period. In 64% of patients the onset was intestinal, while in 36% it was invasive. Diarrhea (in 28.89%) and abdominal pain (in 22.22%) are the most common symptoms of the intestinal stage. Nausea, vomiting and opstipation are less common. The main symptoms of the invasive stage are myalgia (65.54%), high temperature and eyelid edema (57.78%). Facial edema (38.89%), general weakness (24.44%), conjunctivitis (15.56%) and rash (8.89%) are somewhat less common. Heavy sweating, headache, nervousness, psychic instability and fast forgetting occur in a small number of treated patients. Myocarditis and encephalitis occurred in 3.33% of patients. There were 43.33% of patients with mild clinical picture, 40% with mild-to-severe and 16.66% with severe clinical picture. 54.44% of patients were males and 45.56% were females, and it can be said that sex did not influence the severeness of the clinical picture. The youngest patient was 5 years of age, the oldest 72. Most patients were 21-50 years of age but we did not establish statistical importance between clinical picture severeness in regard to age. The shortest period of incubation was 5 days, the longest 40 days. Average incubation period was 18.05 days (x = 18.05). Studying period of incubation and severeness of the clinical picture we established the following (x2 = 28.535). The shorter the incubation period, the severer the disease.
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PMID:[Clinical characteristics of trichinosis]. 901 31

Infections of the nervous system remain a significant source of morbidity and mortality in patients with cancer. This paper reviews the main pathogens and emphasizes some of the principles of diagnosis and management of nervous system infections in cancer patients. Due to immunosuppression, diagnosis is more difficult in this group, secondary to the multitude of potential pathogens, and often by their atypical presentations. Fever or headache are often the only symptoms. Clinical history and general examination should guide appropriate studies such as neuroimaging. CSF analysis, cultures, and brain biopsy. Diagnostic evaluation should be pursued rapidly and aggressively since specific treatments can often reduce morbidity and mortality. Bacterial infections are generally due to break-down of the natural barriers and neutropenia. In neutropenia, Pseudomonas aeruginosa, and Enterobacteriae are the most frequent etiology. If all causes of immunodepression are included, Listeria monocytogenes meningitis is the main bacterial infection encountered. Fungal infections have emerged as a major cause of death among cancer patients. The prognosis of cryptococcosis and histoplasmosis meningitis are markedly improved with new antifungal therapy. Aspergillosis and Mucormycosis, which may cause cerebral abcesses and secondary vascular complications, are almost always fatal. The incidence of meningo-cerebral Candidiasis is often underestimated. Similar to Histoplasmosis, it is frequently disseminated. Viral infections are mainly seen in patients with T-lymphocyte defects. Herpes-simplex virus and Varicella-Zoster virus encephalitis should quicky lead to intravenous treatment with Acyclovir. As in AIDS patients, cerebral toxoplasmosis is the most frequent parasitic infection and appropriate therapy greatly reduces morbidity. It should be emphasized that multitude pathogens are often seen in cancer patients. Despite development of new therapeutic agents, central nervous system infections should still be considered life-threatening. Therefore, antibacterial, antifungal, and antiviral prophylaxis should be the rule for all cancer patients.
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PMID:[Central nervous system infections in patients with malignant diseases]. 903 51

A case of viral encephalitis is described. A 38 year-old female was admitted because of high fever accompanied by cough and headaches. Two days after admission the patient began to exhibit abnormal behavior. Cerebrospinal fluid examination revealed pleocytosis. T2-weighted MRI revealed a high-intensity area located in the corpus callosum bilaterally that gradually increased in intensity within several days the patient's behavior returned to normal. The high-intensity area on MRI persisted for several months but diminished in intensity. Rubella may have been the etiology of the encephalitis.
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PMID:[Encephalitis located at bilateral corpus callosum on MRI--a case report]. 912 43

Headache can be an invaluable premonitory signal of imminent subarachnoid hemorrhage and cerebral infarction and can herald the onset of ominous and sometimes elusive disorders (arterial dissection, encephalitis, systemic and central vasculitides, and cerebral venous thrombosis) which have the potential for neurologic catastrophe and are often not obvious on routine CT brain imaging. Only rarely does serious underlying disease give rise to a headache that exactly mimics a migraine or tension headache. Inevitably, there are atypical features or warning signals. A limited number of serious causes for headache which may be "CT-negative" should be considered in patients with "red flag" manifestations, such as seizures and cognitive changes. These should prompt further investigation with MRI and/or lumbar puncture.
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PMID:Headache as a symptom of ominous disease. What are the warning signals? 915 6

A flavivirus related to the tick-borne encephalitis complex was isolated from the blood of 6 male butchers, aged 24-39 years, in Jeddah, Saudi Arabia in November and December 1995. Two of the patients died and the other 4 recovered completely. Four more patients, 3 males and 1 female, were diagnosed serologically by immunoglobulin M capture enzyme-linked immunosorbent assay and seroconversion in acute and convalescent blood samples examined by indirect immunofluorescent test using Vero cells infected with the isolated virus. The virus identity was confirmed at the Centers for Disease Control and Prevention, Fort Collins, Colorado, USA, by the polymerase chain reaction; it was closely related to Kayasanur Forest disease virus. All infected patients had similar clinical and laboratory symptoms and signs, including fever, headache, generalized body aches, arthralgia, anorexia, vomiting, leucopenia, thrombocytopenia, elevated liver enzymes (serum glutamic oxalacetic and serum glutamic pyruvic transaminases), elevated creatinine phosphokinase, and elevated blood urea. One patient developed symptoms of encephalitis, but survived without any sequel. Skin rash developed in 2 patients, morbilliform on the hands, feet, and lower abdomen of one patient and purpuric associated with melaena in the second patient. Eight of the 10 confirmed patients were working with sheep, and the disease may be a zoonotic viral infection.
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PMID:Isolation of a flavivirus related to the tick-borne encephalitis complex from human cases in Saudi Arabia. 919 62

Bilateral frontal and parietal opercular lesions cause a syndrome characterized by paralysis of the masticatory, facial, pharyngeal, and tongue muscles (the anterior opercular syndrome). The anterior opercular syndrome can occur in patients with herpes simplex encephalitis (HSE), but in most of these patients the diagnosis of HSE was not confirmed. We describe the anterior opercular syndrome in four patients with HSE. In two of these patients, the anterior opercular syndrome dominated the clinical picture, but in the other two patients it was overshadowed by other manifestations of HSE. The diagnosis of HSE was confirmed by detection of herpes simplex virus (HSV) DNA in the CSF (two patients), culture of the HSV from a brain biopsy (one patient), and elevated HSV antibody titers in the CSF (one patient). Our patients made a partial recovery. Acute onset of weakness of masticatory, facial, pharyngeal, and glossal muscles, accompanied by fever, headache, and partial motor seizures of the face should suggest HSE.
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PMID:Anterior opercular syndrome, caused by herpes simplex encephalitis. 927 May 84

Toxoplasma gondii is a frequent cause of subclinical latent human infection and an important opportunistic pathogen that may cause severe disease in immunocompromised patients. Patients with AIDS who have antibodies to T. gondii should be considered at high risk for development of clinical disease (toxoplasmosis). Reactivation of latent infection in the central nervous system is a common HIV/AIDS-related complication in these patients. Typical presenting symptoms are headache, confusion, fever, and focal neurologic deficits. Routine serologic tests cannot distinguish active from latent infection. Neuroradiologic studies may be highly suggestive of toxoplasmic encephalitis, but the definitive diagnosis can be made only by demonstration of toxoplasma in brain tissue. The unique pathogenesis of toxoplasmic encephalitis in patients with AIDS necessitates intensive primary therapy followed by life long suppressive therapy. Clinical and radiographic improvement is usually rapid with appropriate treatment.
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PMID:Recognition and management of toxoplasmosis. 931 66


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