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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 25 year old, human immunodeficiency virus (HIV) seropositive, severe haemophilic patient was treated for suspected Pneumocystis carinii infection with high dose intravenous cotrimoxazole and subsequently with prednisolone. When he improved he was discharged on oral treatment only to return two days later, extremely unwell, with headaches, fever, sweats, tachycardia and hypotension. A lumbar puncture showed modest neutrophil pleocytosis but despite empirical antibiotic treatment with intravenous benzylpenicillin and cefuroxime he continued to deteriorate. Culture of cerebrospinal fluid subsequently grew Enterococcus faecalis that was resistant to trimethoprim and sensitive to ampicillin, rifampicin, and vancomycin. After a change in treatment to intravenous ampicillin and rifampicin he dramatically improved. Enterococcal meningitis is rare in adults but important to recognise and treat appropriately in view of its high mortality and relative resistance to antibiotics. In our case the combination of HIV infection and previous treatment with antibiotics or steroids, or both, were probable predisposing factors.
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PMID:Enterococcal meningitis in an HIV positive haemophilic patient. 190 98

A 40-year-old Japanese Brazilian admitted to our hospital because of headache and fever. He came to Japan 16 years ago and underwent treatment of strongyloidiasis 3 years ago. He showed neck stiffness. CRP was highly elevated, and anti-HTLV-1 antibody was positive. Examination of CSF demonstrated pleocytosis, and neutrophils were dominant. Culture of CSF yielded Enterococcus faecalis, and we diagnosed his condition as enterococcal meningitis. Enterococcal meningitis was cured by administration of ampicillin and ceftriaxone. Enhanced abdominal CT scan was performed in order to detect the infectious focus which induced enterococcal meningitis. It showed wall thickening, wall enhancement and fluid collection in duodenum and upper jejunum. Strongyloides stercoralis was detected in stool and duodenal juice and mucosa. It turned out that strongyloidiasis had persisted. Strongyloidiasis was cured by administration of ivermectin. We supposed that enteric enterococcus invaded the blood by dissemination of Strongyloides stercoralis, and meningitis was induced by hematogenous infection.
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PMID:[Enterococcal meningitis due to strongyloidiasis with HTLV-1 carrier]. 1732 82