Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We evaluated 82 children with bacterial meningitis in 78 institutions in Hokkaido, Japan between 1994 and 1998. The mean number of cases per year was 16.4 (range, 9 to 30). A male predominance occurred with 52 males and 30 females (1.7:1). Median age was 11 months with a range from 1 day to 11 years. Seventy-eight (95%) of the total were less than 5 years old with 55 (67%) less than 2 years old and 45 (55%) less than 1-year old. Four deaths occurred, giving an overall case fatality rate of 4.9%. Sequelae were seen at discharge in 29%, predominantly sensorineural hearing loss, epilepsy and development delay of varying severity. The main causative organisms were Haemophilus influenzae in 49 patients, Streptococcus pneumoniae in 14, Streptococcus agalactiae in 10 and Escherichia coli in 5. The frequency of poor prognosis was 50% for patients with meningitis due to S. pneumoniae or S. agalactiae compared with 27% for patients with meningitis due to H. influenzae.
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PMID:[A study of bacterial meningitis in Hokkaido between 1994 and 1998]. 1083 39

To evaluate the spectrum and regulation of matrix metalloproteinases (MMPs) in bacterial meningitis (BM), concentrations of MMP-2, MMP-3, MMP-8, and MMP-9 and endogenous inhibitors of metalloproteinases (TIMP-1 and TIMP-2) were measured in the cerebrospinal fluid (CSF) of 27 children with BM. MMP-8 and MMP-9 were detected in 91% and 97%, respectively, of CSF specimens from patients but were not detected in control patients. CSF levels of MMP-9 were higher (P<.05) in 5 patients who developed hearing impairment or secondary epilepsy than in those who recovered without neurological deficits. Levels of MMP-9 correlated with concentrations of TIMP-1 (P<.001) and tumor necrosis factor-alpha (P=.03). Repeated lumbar punctures showed that levels of MMP-8 and MMP-9 were regulated independently and did not correlate with the CSF cell count. Therefore, MMPs may derive not only from granulocytes infiltrating the CSF space but also from parenchymal cells of the meninges and brain. High concentrations of MMP-9 are a risk factor for the development of postmeningitidal neurological sequelae.
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PMID:Matrix metalloproteinase (MMP)-8 and MMP-9 in cerebrospinal fluid during bacterial meningitis: association with blood-brain barrier damage and neurological sequelae. 1091 1

Brucellosis is an infectious disease with multisystemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningoencephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningovascular syndromes, are rarely encountered. We present a patient with epileptic seizures and aggressive mood due to chronic neurobrucellosis of 2.5 y duration, which was misdiagnosed as bacterial meningitis and epilepsy. This form of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neurobrucellosis should be considered in patients presenting with recurrent or chronic meningitis syndromes with or without seizure from endemic areas for brucellosis.
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PMID:Epileptic seizure: an atypical presentation in an adolescent boy with neurobrucellosis. 1223 82

A 55-year-old female patient developed a severe chronic lumbar pain syndrome over a period of 17 years. An intervertebral disc operation was performed 5 years after the start of the painful illness. The patient later developed resistance to therapy and was unable to stand or walk. She was confined to bed and wheelchair and socially completely withdrawn. Drug therapy and invasive therapeutic techniques escalated. An intrathecal catheter for morphine administration had to be removed owing to bacterial meningitis, and repeated malfunction led to several revisions of an epidural catheter. Withdrawal of the morphine therapy, carried out with the patient's agreement, was complicated by an epileptic seizure and an acute circulatory failure with cerebral hypoxia. The succeeding severe amnestic syndrome extinguished all recollection of the last 20 years, including the entire course of the painful illness. The patient could then be mobilised without pain. Consistent care avoided a relapse into the pain syndrome as the amnestic syndrome gradually receded. The patient was fully able to accept responsibility and not longer required special pain therapy. The course demonstrates that chronic pain disorders of a predominantly psychodynamic, and therefore corticocerebral, genesis are dependent on an intact memory. In such cases memory failure can induce pain relief.
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PMID:[Forgotten pain]. 1279 75

Nosocomial meningitis is uncommon in children. We reviewed the medical records of all children who developed bacterial meningitis at least 72 hours after admission to Mackay Memorial Hospital for the period July 1992 through June 2000. Clinical manifestations, predisposing factors, pathogens, and outcomes were analyzed. Twenty-two cases of nosocomial meningitis were identified, comprising 9.2% (22/239) of all pediatric cases of bacterial meningitis during the study period. The male-to-female ratio was 14:8. All patients were younger than 6 months of age except for one, who was 7 years old. The mean duration between admission and onset of meningitis was 15.3 days (range, 3 to 58 days). Twenty-two organisms were isolated, including 13 Gram-negative bacteria (59%) and 9 Gram-positive bacteria (41%). The most common pathogen was Escherichia coli (5 cases), followed by Enterobacter cloacae (3), Staphylococcus aureus (3), and Chryseobacterium meningosepticum (3). Seventeen patients (77%) had concomitant bacteremia. Predisposing factors for acquisition of nosocomial meningitis included previous treatment with broad-spectrum antibiotics (68%), prematurity with very low birth weight (41%), and total parenteral nutrition (32%). Two patients (9%) had previous neurosurgical intervention. Four patients (18%) died, 3 of whom were low birth weight premature infants. Nine patients (41%) had sequelae, including developmental delay, hydrocephalus, hearing impairment, and epilepsy. Neurosurgery was not a significant risk factor for the development of nosocomial meningitis, while very low birth weight played an important role. Previous intraventricular hemorrhage or hydrocephalus, prematurity with very low birth weight, infection with Gram-negative bacteria, and prior broad-spectrum antibiotic administration were associated with poor outcome.
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PMID:Characteristics of nosocomial bacterial meningitis in children. 1506 Jun 85

We evaluated 83 children with bacterial meningitis in 67 of 81 insitutions in Hokkaido, Japan between 1999 and 2003 by questionnaire. The incidence of bacterial meningitis in children aged < 5 years and 5 < or =, < 10 years was 6.3 and 0.7 cases per 100, 000 children/year. The incidences of meningitis due to Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus agalactiae in children aged < 5 years were 3.7, 1.4 and 0.8. Median age was 13 months ranging from 0 day to 9 years. Seventy-four (89.1%) of the total were less than 5 years old with 39 (47.0%) less than 1 year old. Major causative organisms were H. influenzae in 51 patients, S. pneumoniae in 18, S. agalactiae in 9 and E. coli in 3. Four deaths occurred, giving an overall case mortality rate of 4.8%. Sequelae were seen at discharge in 25.3%, predominantly epilepsy, hearing loss, and developmental delay of varying severity. The frequency of poor prognosis was 55.6% for patients with meningitis due to S. pneumoniae compared with 21.6% for H. influenzae and 22.2% for S. agalactiae.
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PMID:[A study of bacterial meningitis in Hokkaido between 1999 and 2003]. 1624 77

Aquaporin-4 (AQP4) is expressed in astrocytes throughout the central nervous system, particularly at the blood-brain and brain-cerebrospinal fluid barriers. Phenotype analysis of transgenic mice lacking AQP4 has provided compelling evidence for involvement of AQP4 in cerebral water balance, astrocyte migration, and neural signal transduction. AQP4-null mice have reduced brain swelling and improved neurological outcome in models of (cellular) cytotoxic cerebral edema including water intoxication, focal cerebral ischemia, and bacterial meningitis. However, brain swelling and clinical outcome are worse in AQP4-null mice in models of vasogenic (fluid leak) edema including cortical freeze-injury, brain tumor, brain abscess and hydrocephalus, probably due to impaired AQP4-dependent brain water clearance. AQP4 deficiency or knock-down slows astrocyte migration in response to a chemotactic stimulus in vitro, and AQP4 deletion impairs glial scar progression following injury in vivo. AQP4-null mice also manifest reduced sound- and light-evoked potentials, and increased threshold and prolonged duration of induced seizures. Impaired K+ reuptake by astrocytes in AQP4 deficiency may account for the neural signal transduction phenotype. Based on these findings, we propose modulation of AQP4 expression or function as a novel therapeutic strategy for a variety of cerebral disorders including stroke, tumor, infection, hydrocephalus, epilepsy, and traumatic brain injury.
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PMID:Three distinct roles of aquaporin-4 in brain function revealed by knockout mice. 1656 96

The evolution of the endoscopic endonasal transsphenoidal technique, which was initially reserved only for sellar lesions through the sphenoid sinus cavity, has lead in the last decades to a progressive possibility to access the skull base from the nose. This route allows midline access and visibility to the suprasellar, retrosellar and parasellar space while obviating brain retraction, and makes possible to treat transsphenoidally a variety of relatively small midline skull base and parasellar lesions traditionally approached transcranially. We report our current knowledge of the endoscopic anatomy of the midline skull base as seen from the endonasal perspective, in order to describe the surgical path and structures whose knowledge is useful during the operation. Besides, we describe the step-by-step surgical technique to access the different compartments, the "dangerous landmarks" to avoid in order to minimize the risks of complications and how to manage them, and our paradigm and techniques for dural and bony reconstruction. Furthermore, we report a brief description of the useful instruments and tools for the extended endoscopic approaches. Between January 2004 and April 2006 we performed 33 extended endonasal approaches for lesions arising from or involving the sellar region and the surrounding areas. The most representative pathologies of this series were the ten cranioparvngiomas, the six giant adenomas and the five meningiomas; we also used this procedure in three cases of chordomas, three of Rathke's cleft cysts and three of meningo-encephaloceles, one case of optic nerve glioma, one olfactory groove neuroendocrine tumor and one case of fibro-osseous dysplasia. Tumor removal, as assessed by post-operative MRI, revealed complete removal of the lesion in 2/6 pituitary adenomas, 7/10 craniopharyngiomas, 4/5 meningiomas, 3/3 Rathke's cleft cyst, 3/3 meningo-encephalocele. Surgical complications have been observed in 3 patients, two with a craniopharyngioma, one with a clival meningioma and one with a recurrent giant pituitary macroadenoma involving the entire left cavernous sinus, who developed a CSF leak and a second operation was necessary in order to review the cranial base reconstruction and seal the leak. One of them developed a bacterial meningitis, which resolved after a cycle of intravenous antibiotic therapy with no permanent neurological deficits. One patient with an intra-suprasellar non-functioning adenoma presented with a generalized epileptic seizure a few hours after the surgical procedure, due to the intraoperative massive CSF loss and consequent presence of intracranial air. We registered one surgical mortality. In three cases of craniopharyngioma and in one case of meningioma a new permanent diabetes insipidus was observed. One patient developed a sphenoid sinus mycosis, cured with antimycotic therapy. Epistaxis and airway difficulties were never observed. It is difficult todav to define the boundaries and the future limits of the extended approaches because the work is still in progress. Such extended endoscopic approaches, although at a first glance might be considered something that everyone can do, require an advanced and specialized training.
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PMID:Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. 1838 14

This study assessed the validity of cerebrospinal fluid oxidative status of pediatric patients with central nervous system diseases, using the Diacron-Reactive Oxygen Metabolites test (d-Roms; Diacron International s.r.l.; Grosseto, Italy). Eighty-seven pediatric patients (8 with bacterial meningitis, 18 with aseptic meningitis, 23 with febrile seizures, 6 with rotavirus gastroenteritis-induced convulsions, 16 with epilepsy, 2 with adrenoleukodystrophy, 2 with multiple sclerosis, and 12 control subjects) were enrolled. An analysis of the infection-associated group (bacterial meningitis, aseptic meningitis, febrile seizures, and rotavirus gastroenteritis-induced convulsions) indicated that cerebrospinal fluid Diacron-Reactive Oxygen Metabolite levels in the bacterial meningitis group were significantly higher than in other infection-associated groups. In the bacterial meningitis group, the cerebrospinal fluid Diacron-Reactive Oxygen Metabolite levels obtained after improvement were significantly decreased compared with pre-improvement values. In the noninfection-associated group (epilepsy, adrenoleukodystrophy, and multiple sclerosis), the cerebrospinal fluid Diacron-Reactive Oxygen Metabolite levels in symptomatic epilepsy patients were higher than in cryptogenic epilepsy patients and control subjects, but not significantly. Progressive patients with adrenoleukodystrophy or multiple sclerosis demonstrated high Diacron-Reactive Oxygen Metabolite levels compared with another early-stage adrenoleukodystrophy patient. Oxidative stress may be associated with the pathogenesis of various pediatric central nervous system diseases. Cerebrospinal fluid Diacron-Reactive Oxygen Metabolite levels may correlate with clinical status in these diseases.
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PMID:Cerebrospinal fluid Diacron-Reactive Oxygen Metabolite levels in pediatric patients with central nervous system diseases. 1863 49

Male monozygotic twins with genetically determined severe myoclonic epilepsy in infancy are described. Although seizure onset, clinical seizure symptomatology, and motor and mental development were almost identical until age 38 months, their clinical courses then became discordant. The emergence of myoclonus was delayed by 12 months in twin 1 compared with twin 2. Regression in language development, which is a common feature of severe myoclonic epilepsy in infancy, was obvious in twin 2 after the emergence of myoclonus, whereas twin 1 did not demonstrate any regression. The clinical-course discordance between twins was attributable to bacterial meningitis, which twin 1 developed at age 35 months. Bacterial meningitis may have affected the clinical course of severe myoclonic epilepsy in infancy in twin 1, resulting in delayed onset of myoclonus and more favorable language development in twin 1 than in twin 2, who did not experience bacterial meningitis.
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PMID:Monozygotic twins with severe myoclonic epilepsy in infancy discordant for clinical features. 1863 57


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