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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A newborn infant with hyaline membrane disease and aspiration pneumonia developed purulent meningitis on day 19, three days after discontinuation of ampicillin sodium and gentamicin sulfate therapy. Therapy with gentamicin, both systemically and intrathecally, for two weeks was ineffective. During this time each of four specimens of cerebrospinal fluid contained two serotypes of Escherichia coli, namely, O83:H4 and O75:H5. The antibiograms of the two strains were identical, both being susceptible to gentamicin and ampicillin. Treatment with ampicillin resulted in prompt disappearance of the infecting microorganisms and recovery from the infection. One of the strains (O75:H5) produced an antigen cross-reacting with the capsular antigen of Haemophilus influenzae type B; the other did not. The patient developed O antibodies in substantial titers against E coli O83 but not against E coli O75.
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PMID:Meningitis due to two serotypes of Escherichia coli. An infant who recovered. 31 55

Common intracranial complications following head injury are meningitis, usually associated with a basilar skull fracture or open-depressed skull fracture; delayed hematoma; hydrocephalus; and vascular injuries. Prophylactic antibiotics are not recommended for the management of basilar skull fractures. The best means of preventing infection from open-depressed skull fractures is operative debridement and thorough irrigation, though recent evidence suggests that select cases can be safely managed without operation. Serial CT scans should be obtained in severely head-injured patients to identify delayed hematomas. CT and MRI scans obtained several weeks or months after severe head injury frequently reveal enlarged ventricles, though only a small percentage of these patients have clinical hydrocephalus. Those that do, often benefit from a shunt. Vascular injuries frequently are not detected until ischemic symptoms develop hours or days after the injury. Recommended treatment for intimal tears or dissection is full anticoagulation, but in those with cerebral contusions or other intracranial lesions, this may present an unacceptable risk for intracranial hemorrhage. Pulmonary infections frequently occur following head injury, and can be associated with admission to the ICU and intubation. A large percentage of these infections are caused by enteric gram-negative organisms, and aggressive treatment with appropriate antibiotics is necessary. Aspiration of gastric contents is common in head-injured patients and is frequently complicated by bacterial superinfection. The routine use of antacids and H2 blocking agents leads to bacterial colonization of the stomach with anaerobes and gram-negative aerobes. Thus, empiric therapy for aspiration pneumonia should include clindamycin. Sinusitis is a frequent cause of fever and leukocytosis in patients with nasotracheal or nasogastric tubes in place for several days and often subsides spontaneously with removal of the tubes. Pulmonary edema is often caused by excessive fluid administration during resuscitation of these patients, and can be avoided by monitoring central venous pressures. Pulmonary edema may also be caused by ARDS, excessive catecholamine release, or primary cardiac failure. Most of these patients will benefit from early intubation and PEEP. Pulmonary emboli most often originate from deep venous thrombi, and there is increasing evidence that prophylaxis with low-dose heparin and pulsating boots can significantly reduce the incidence of both complications. Erosive gastritis is found in the majority of severely head-injured patients and may be due to ischemia of the gastric mucosa as well as gastric hyperacidity.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Complications of head injury and their therapy. 182 50

A case of Streptococcus suis meningitis is observed in a 39-year-old and previously healthy meat factory worker. Neurological recovery was incomplete despite adequate and sustained antimicrobial therapy. Early deafness was demonstrated by brainstem auditory evoked potentials. Death due to aspiration pneumonia, cardiac arrest and subsequent cerebral anoxia occurred late in the course of the illness.
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PMID:Fatal Streptococcus suis meningitis in man. 192 55

Pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.
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PMID:Pseudallescheria boydii infection of the central nervous system. 218 80

Within a three-month period 13 cases of listeriosis in the newborn were seen at the National Women's Hospital, Auckland. Eleven presented in the first 24 hours of life, the most common feature being respiratory difficulty in low birth weight infants. Meconium-stained liquor was noted in nine cases. The constant finding in all cases was an aspiration pneumonia which appeared to be of intrauterine origin from an infected amniotic cavity. There was also evidence of septicaemia in nine cases, and two infants survived meningitis which developed at 1 week. Maternal symptoms were mild and variable, and in only one case were they proved to be due to listerial infection. The mothers came from different suburbs of Auckland and no common source of infection was found.
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PMID:Epidemic listeriosis in the newborn. 509 70

Fifty consecutive patients with metastatic carcinoma who underwent cryohypophysectomy were studied. Of these, 26 had breast cancer, 19 had prostatic cancer, one had malignant melanoma, one had cancer of the kidney, and three had metastatic adenocarcinoma from an unknown primary tumour. After cryohypophysectomy, excellent pain relief was obtained in 48% of patients, good or acceptable pain relief was obtained in 40%, and poor or no relief in 12%. Two patients died: one of aspiration pneumonia and one of an unknown cerebral cause. Sixteen patients developed diabetes insipidus, of whom three required therapy with vasopressin; eight patients developed a cerebrospinal fluid leak, two of whom required surgical repair; and four patients developed meningitis, which resolved in three after antibiotic therapy. Results are compared with those from other published reports. Pain relief from cryohypophysectomy is surmised to be due to the production of endorphins, but no proof of this is available.
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PMID:Cryohypophysectomy for the relief of pain in malignant disease. 669 92

The transoral-transpharyngeal approach is a reliable and technically sound method for gaining anterior extradural exposure to the craniocervical junction. We report 23 patients undergoing this approach for pathology lying between the inferior clivus and third cervical vertebra. Pathology included 6 patients with congenital malformations of the odontoid process, 4 patients with basilar invagination caused by rheumatoid arthritis, 2 patients with atlantoaxial subluxation caused by Down's syndrome, and 1 each with Chiari I malformation, pseudogout of C1/C2, ossification of the posterior longitudinal ligament, and chronic dens dislocation caused by trauma. Malignant tumors included 4 chordomas, 2 giant cell tumors of C1-C3, and 1 chondrosarcoma. Orotracheal intubation without tracheotomy was used in 22 patients. Sixteen of these 22 patients were extubated either immediately or within 24 hours. Six complications occurred in 5 patients and included a palatal dehiscence in 2, delayed oropharyngeal hemorrhage, prolonged endotracheal intubation because of severe tongue edema, and 1 case each of meningitis and aspiration pneumonia responsive to intravenous antibiotics. No deaths, local infections, or postoperative cerebrospinal fluid leaks occurred. Neurologic symptoms of cord compression improved or stabilized in all patients. The transoral-transpharyngeal approach is an effective means for extradural decompression of the anterior craniocervical junction and for exposure of selected tumors at this site.
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PMID:Transoral-transpharyngeal approach to the craniocervical junction. 756 10

Granulomatous meningitis attributable to Coccidioides immitis was diagnosed on postmortem examination in a 4-year-old Border Collie. Clinical signs included CNS disease, aspiration pneumonia secondary to a megaesophagus, and otitis externa. Central nervous system signs included central vestibular and cranial nerve dysfunction. Cerebellar and medullary infiltrates seen on histologic examination affected cranial nerves VIII, IX, and X. Despite extensive diagnostics, diagnosis was not made antemortem. Analysis of CSF suggested suppurative meningitis, but bacteriologic culture results were negative. Coccidioides endospores were identified on reexamination of brain tissue. The clinical course of disease and rate of Coccidioides immitis infection is variable. Causative agents of granulomatous or inflammatory CNS disease may include fungal infection more often than is currently suspected.
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PMID:Granulomatous meningitis caused by Coccidioides immitis in a dog. 953 Apr 20

We report a 64-year-old Japanese woman who died one year after the onset of progressive gait disturbance and dementia. She noted a difficulty in holding a glass and hand tremor in June of 1996 when she was 63 years old. In July of 1996, she tended to lean toward left when she walked. She also noted truncal titubation. In November of 1996, she started to have visual hallucination and delusion in which she said "I see something is flying on the wall.", "Somebody has come into my room", and things like that. She was admitted to our service on November 22, 1996. On admission, she was alert and general physical examination was unremarkable. Neurologic examination revealed disturbance in recent memory. Hasegawa's dementia rating scale was 22/30. She showed vivid visual hallucination with colors in which she saw faces of dwarfs and angels, a space ship, and others. Higher cerebral functions were normal. She showed left oculomotor palsy which was a sequel of an aneurysm and subarachnoid hemorrhage nine years before. Otherwise cranial nerves were unremarkable. She showed ataxic gait, limb ataxia, truncal titubation, and postural hand tremor. She had no weakness and no muscle atrophy. Deep tendon reflexes were within normal limits. Plantar response was flexor. Sensation was intact. Laboratory examination was also unremarkable. Complete survey for occult malignancy was negative. CSF was under a normal pressure and cell count was 1/microliter, total protein 27 mg/dl, and sugar 68 mg/dl. Cranial CT scan was unremarkable. MRI was not obtained because of the presence of an aneurysm clip in the left internal carotid-posterior communication artery junction. She showed progressive deterioration in her mental function. By January 1997, she became unable to stand or walk with marked dementia. Repeated CSF exams and cranial CT scans were unremarkable. She suffered from several episodes of aspiration pneumonia. A trial of three days methylprednisolone pulse therapy was given starting on March 7, 1997, which was of no effect on her neurologic status. On March 28, 1997, she was intubated because of acute respiratory distress syndrome. In April 2, her body temperature rose to 38 degrees C. On April 9, 1997, her blood pressure dropped and resuscitation was unsuccessful. She was pronounced dead on the same day. The patient was discussed in a neurologic CPC and the chief discussant arrived at the conclusion that the patient had primary leptomeningeal lymphoma. Other possibilities entertained among the audience included brain stem encephalitis of unknown type, carcinomatous cerebellar degeneration plus limbic encephalitis, Creutzfeldt-Jakob disease, thalamic degeneration, and progressive multifocal leukoencephalopathy. Post-mortem examination revealed thickening and clouding of the leptomeninges; Gram-positive diplococci were found in the leptomeninges. This meningitis appeared to have been an complication in the terminal stage of her illness. Microscopic examination revealed astrocytosis in the midbrain tegmentum. Cerebral cortices showed only mild astrtocytosis. No cerebellar atrophy was seen and Purkinje cells were retained which excluded paraneoplastic cerebellar degeneration. Neuropathologic diagnosis was bacterial meningitis, however, the presence of brain stem encephalitis prior to the onset of bacterial meningitis could not be excluded. It is interesting to note that the diagnosis of the primary neurologic disease of this patient was not easy even after autopsy. As autopsy permission was obtained only for the brain, it was not clear whether or not this patient had an occult malignancy somewhere in her body, however, there was no evidence to indicate paraneoplastic degeneration of the central nervous system. As the patient did not have meningeal signs until one month before her death, it is difficult to ascribe her entire neurologic problems to her meningitis. Finally, her visual hallucination was vivid and colorful; we thought this might have been
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PMID:[A 64-year-old woman with progressive gait disturbance and dementia for one year]. 978 11

Fever is often an indication of a serious illness in children. In areas endemic to malaria, hospital workers should check a febrile child for malaria parasites. Children with a fever associated with meningitis or malaria need immediate attention. To diagnose meningitis: microscopic examination of cerebrospinal fluid obtained by lumbar puncture is the only reliable method. If a febrile child also has a stiff neck, health workers should immediately administer antibiotic treatment without waiting for the results of the lumbar puncture. If available and in epidemic situations, oily chloramphenicol may be administered, since it is effective in a single dose. Treatment with other antibiotics should last for 10 days in children and 14-21 days for young infants. To diagnose malaria in endemic areas: laboratory technicians should examine thick and thin blood films of sick children with fever. Health workers must consider as medical emergencies children who have a slide positive for malaria parasites plus severe anemia, hypoglycemia, deep rapid breathing, any indication of kidney malfunction or failure, or altered consciousness. They should begin antimalarial treatment with quinine, the drug of choice for severe and complicated malaria. In cases of convulsions lasting longer than 5 minutes, health workers should administer anticonvulsants and take actions to prevent aspiration pneumonia. If the fever persists for 14 days or if the child does not emerge from unconsciousness and someone in the family has active tuberculosis, health workers should consider tuberculous meningitis. If a child with malaria has low hemoglobin levels (5 g/dl) and many malaria parasites in the blood and is in heart failure, a blood transfusion (15-20 ml/kg whole blood over 4 hours) and infusion of 1 mg/kg fursemide (to prevent cardiac failure) are needed. If the preceding case has pulmonary edema, a single dose of fursemide at the same dosage is needed to prevent overloading of the circulation. Health workers should closely monitor that intravenous fluids not exacerbate brain swelling.
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PMID:Managing meningitis and severe malaria. 1229 72


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