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)

Seven cases of pituitary abscess are presented and the relevant world literature is reviewed. An enlarged sella co-existing with bacterial meningitis, or bacterial meningitis coinciding with a known or suspected pituitary tumor should suggest the diagnosis of pituitary abscess. Visual field defects should evoke similar suspicion when present in a patient with meningitis. This reasoning enabled us to make the first reported preoperative diagnosis of pituitary abscess. Therefore, in the management of purulent meningitis, we recommend the following: first, skull films are mandatory; second if the sella turcica is abnormal, the correct presumptive diagnosis is pituitary abscess; and third, if prompt improvement does not follow appropriate antibiotic therapy, the suspected abscess should be explored and drained via the transsphenoidal approach.
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PMID:Pituitary abscesses. Report of seven cases and review of the literature. 84 49

Lysozyme activity was measured in cerebrospinal fluid (CSF) from 114 patients with inflammatory (bacterial and serous meningitis, polyradiculitis, encephalitis) and non-inflammatory (multiple sclerosis, CNS tumors, cerebral vascular diseases) CNS diseases. Highly elevated values were found consistently in patients with bacterial meningitis. Elevated values were found also in patients with encephalitis, polyradiculitis, multiple sclerosis and CNS tumors, but a considerable overlapping between these groups and normal controls precludes the use of CSF lysozyme measurements as a diagnostic aid in the latter disease groups. Simultaneous measurements of lysozyme, albumin and IgG in CSF and serum suggested that the mechanism for increased CSF lysozyme values in bacterial meningitis is mainly a breakdown of the blood/brain barrier, whereas the increased CSF lysozyme values in the remaining groups of patients are more likely caused by production of lysozyme by cells within the meninges (neutrophilic granulocytes, monocytes?).
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PMID:Lysozyme activity in cerebrospinal fluid. Studies in inflammatory and non-inflammatory CNS disorders. 85 79

A 25-year-old man was previously healthy until he contracted acute Propionibacterium acnes meningitis. Comparison with previous reports of de novo diphtheroid meningitis suggests that this entity can appear with features that are not characteristic of acute bacterial meningitis, including (1) stroke-like syndromes, (2) an afebrile course, and (3) a cerebrospinal fluid with a mononuclear pleocytosis and normal glucose level. The appropriate choice and dosage of antimicrobial agent must be guided by more than in vitro sensitivity data to prevent relapse and possible chronic meningitis. Although diphtheroids are as a rule exquisitely sensitive to penicillin, predictably high tissue levels of drug in diphtheroid meningitis are best achieved with chloramphenicol treatment. In the appropriate settling, the isolation of diphtheroids from cerebrospinal fluid should not be discounted as a "contaminant."
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PMID:Propionibacterium acnes meningitis in a previously normal adult. 87 34

Measurement of cerebrospinal fluid lactic acid by gas liquid chromatography and by an enzymatic Monotest lactate test was evaluated for the early detection of bacterial meningitis in 396 patients. Spinal fluid specimens from 62/62 patients with a bacterial or mycoplasma etiology yielded lactate levels greater than the upper limits of normal, whereas specimens from 334 patients with no bacterial involvement gave values within the normal range. The duration of elevated CSF lactate values coincided with the clinical response to therapy. When considered along with the history and physical examination of the patient, determination of lactic acid proved to be a rapid and reliable diagnostic test for the early detection of untreated as well as partially treated pyogenic meningitis.
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PMID:Cerebrospinal fluid lactic acid levels in meningitis. 89 5

Between July 1, 1971, and June 30, 1974, thirty-nine cases of bacterial meningitis were diagnosed at the Alaska Native Health Service Hospital at Bethel, Alaska. Thirty-two (82%) occurred in infants less than one year of age. Haemophilus influenzae (H. influenzae) was the predominant causative agent, and was isolated from 23 (72%) of the 32 patients under one year of age. The annual incidence of H. influenzae meningitis in the Bethel area was 63/100,000, and the annual incidence of H. influenzae meningitis in children less than five years of age was 474/100,000 cases.
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PMID:Bacterial meningitis in southwestern Alaska. 92 Jul 27

Because cerebrospinal fluid (CSF) antibiotic levels fail to predict either clinical success or relapse in the treatment of bacterial meningitis, we examined simultaneous antibiotic concentrations in the blood, brain, and CSF of control rabbits and of animals with experimental pneumococcal meningitis. Cefamandole pharmacokinetics were analyzed in detail and compared with those of cephalothin, ampicillin, penicillin G, and tobramycin. After 4 h of continuous intravenous infusion, cefamandole reached concentrations in both brain and CSF in excess of the minimal bactericidal concentration for the test organism and compared favorably with ampicillin and penicillin in achieving bacteriological cure. Cephalothin levels in the central nervous system remained undetectable in both control and infected animals during this time. Tobramycin concentrations were measurable in the CSF, but not in brain tissue in association with an inflammatory stimulus.
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PMID:Blood, brain, and cerebrospinal fluid concentrations of several antibiotics in rabbits with intact and inflamed meninges. 93 69

Hypoglycorrhachia (abnormally low cerebro spinal fluid glucose content) eludes exact numerical definition, largely because of the dynamic equilibrium between blood and CSF glucose. A group of 181 pediatric patients with a CSF glucose less than 50 mg/100 ml or a CSF/blood glucose ratio less than 0.50 were studied. Hypoglycorrhachia was present in patients with bacterial meningitis, aseptic meningitis, meningeal carcinomatosis, subarachnoid hemmorrhage, and hypoglycemia. Markedly diminished CSF glucose values were seen primarily in patients with bacterial meningitis. Higher CSF/blood glucose ratios predominated in those with hypoglycemia and neonates with low-normal blood sugars. Following bacterial meningitis and hypoglycemia, aseptic meningitis (including five children with documented enterovirus meningitis and one with documented mumps meningitis) was the third most common cause of hypoglycorrhachia in children. When readily available, positive CSF viral cultures may allow early cessation of antibiotic therapy in two types of patients with meningitis and hypoglycorrhachia: (1) those receiving previous recent antibiotic therapy, and (2) those with CSF findings more typical of a bacterial meningitis.
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PMID:Hypoglycorrhachia in pediatric patients. 93 86

Eighteen of 349 cases (5.2 per cent) of bacterial meningitis seen between 1949 and 1973 were hospital-associated (developed after admission to the hospital). The patients were adults, usually males, and developed symptoms and signs of meningitis from 2 to 23 days (mean, 10.1 days) after hospital admission. The diagnosis of bacterial meningitis was made from less than 1 day to 15 days (mean, 4.8 days) after the onset of symptoms. Fourteen of the 18 patients had received antibiotics during the week prior to developing meningitis. Nine (50 per cent) had a chronic, noninfection, underlying illness. Diagnostic or surgical procedures involving the neuraxis or adjacent structures preceded the development of meningitis in 10 of the 18 patients (56 per cent). Only 6 of the 18 patients survived their infection. Prompt recognition, diagnosis, and therapy of hospital-associated meningitis in high-risk patients may reduce the significant mortality.
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PMID:Hospital-associated bacterial meningitis. 93 80

The limulus lysate assay was utilized to detect and quantitate endotoxin in cerebrospinal fluid from 232 patients with suspected meningitis. The assay was positive in initial specimens of CSF from all 86 patients with gram-negative bacterial meningitis and was uniformly negative in the remaining 146 patients with a variety of infectious and noninfectious processes. Endotoxin concentrations in initial specimens of CSF from patients with gram-negative meningitis ranged from 4 to 2,000 ng/ml. No correlation between initial CSF levels of endotoxin and initial clinical or laboratory variables of infection was noted. With antibiotic therapy, CSF concentrations of endotoxin fall rapidly to undetectable levels after five days.
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PMID:Cerebrospinal fluid endotoxin concentrations in gram-negative bacterial meningitis. 94 92

Bacterial meningitis remains a life-threatening infection even in the present antibiotic era; thus, any abnormality which predisposes a patient to a recurrence of this serious disease, must be identified and corrected. This report describes the histroy of a 12-year old boy with a profound neurosensory hearing loss, a related absence of vestibular function and a Mondini-type of temporal bone dysplasia who developed recurrent episodes of meningitis which were due to an idiopathic cerebrospinal fluid otorrhea. Even though the meningitis was labyrinthogenic in origin, the patient did not experience the associated symptoms of hearing loss and/or vertigo since the affected inner ear was clinically unreactive. By surgically exploring the middle ear, the presence of a cerebrospinal fluid otorrhea was confirmed. The leak was observed to be coming from a defect in the stapes footplate, and it was controlled by firmly packing the inner ear vestibule with muscle. A remarkable similarity exists between the patient described above and the 15 previously reported cases of meningitis due to a spontaneous cerebrospinal fluid otorrhea. Generally, the problem occurred in young children, the average age being 6.4 years; male and female were equally afflicted. All 15 previously reported cases had a severe neurosensory hearing loss which was unilateral in 10 individuals and bilateral in the other five. In 11 of the case reports, the vestibular function was evaluated, and the labyrinth was noted to be unreactive in the affected ear. An associated congenital abnormality of the inner ear was described in 11 of the patients reviewed. Anatomically, in 13 cases, the leak was observed to be coming from the oval window area. Other affected sites included one report of a fissure of the promontory and one report of a defect in the roof of the eustachian tube. Multiple surgical procedures were required in 11 of the 15 patients in order to identify the exact source of the otorrhea and to seal it permanently. In three cases, the successful procedure was a middle ear exploration with stapedectomy and packing of the inner ear vestibule. Overall, a total of 36 operations was performed in the 15 patients reviewed. In conclusion, when the physician is confronted by a case of meningitis in a patient with a unilateral or bilateral total loss of hearing and vestibular function, the possible presence of an idiopathic cerebrospinal fluid leak should be considered, expecially if radiographic studies demonstrate a temporal bone dysplasia. In these selected cases, if the etiology of the meningitis is obscure, a middle ear exploration should be performed both for diagnostic purposes as a means to ascertain definitely the presence of a leak and for therapeutic purposes to seal it effectively.
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PMID:Recurrent meningitis secondary to idiopathic oval window CSF leak. 96 15


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