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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The synthesis of new cephalosporin antibiotics has provided agents which can effectively be used to treat most of the different forms of meningitis. None of the first generation cephalosporins can be considered acceptable as agents to treat meningitis. Cefuroxime can be used to treat meningitis due to Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis in children. Agents such as cefotaxime and ceftriaxone are appropriate for neonatal meningitis due to Escherichia coli and group B streptococci, but not Listeria monocytogenes. Cefotaxime, ceftriaxone, ceftizoxime and ceftazidime have all proved effective as therapy of meningitis in children and adults when the pathogens are pneumococci, H. influenzae or N. meningitidis, but they have not been shown to yield an improved mortality or lower morbidity in spite of much greater cerebrospinal fluid (CSF) bactericidal titres. Cefotaxime, ceftizoxime, ceftriaxone and ceftazidime have been effective as therapy of meningitis due to E. coli, K. pneumoniae and Proteus species, but failures have occurred with all of the cephalosporins when used to treat meningitis due to Enterobacter spp. and Serratia marcescens. Only ceftazidime yields adequate CSF concentrations to treat meningitis due to Pseudomonas aeruginosa. Overall, the cephalosporins can now be considered a major component of the therapy of acute bacterial meningitis irrespective of the age group to be treated.
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PMID:Cephalosporins in the treatment of meningitis. 331 97

From 1940 to 1984, 19 cases of septic dural-sinus thrombosis have been diagnosed at the Massachusetts General Hospital, and some 136 cases have been reported from other institutions. Septic thrombosis most frequently involves the cavernous sinuses (96 cases). Facial or sphenoid air sinus infection often precede cavernous-sinus disease. In addition to the classical signs of proptosis, chemosis, and oculomotor paralysis, isolated sixth-nerve palsy and hypo- or hyperesthesia of the fifth nerve may be found. The major pathogens associated with cavernous-sinus infection include Staphylococcus aureus, other gram-positive organisms, and anaerobes. Septic lateral-sinus thrombosis (64 cases) is almost exclusively a complication of otitis media and/or mastoid infection. Organisms causing this infection include Proteus species, Escherichia coli, S. aureus, and anaerobes. Septic thrombosis of the superior sagittal sinus (23 cases) most frequently accompanies bacterial meningitis or air sinus infection. Causative organisms include Streptococcus pneumoniae, S. aureus, other streptococci, and Klebsiella species. Because septic dural-sinus thrombosis is rare, this disease is frequently misdiagnosed. Evaluation should include lumbar puncture, air sinus films, and computed tomographic scan with contrast. Other helpful diagnostic tests may include carotid angiography, and dynamic brain scan. Orbital venography is the most definitive study in cases of chronic cavernous-sinus thrombosis. Therapy should include intravenous antibiotics and early surgical drainage of purulent exudate in the air sinuses or mastoid regions. Retrospective analysis suggests that treatment with heparin may reduce mortality in carefully selected cases of septic cavernous-sinus thrombosis. Anticoagulation is not recommended in other forms of septic dural-sinus thrombosis. Mortality in the antibiotic-era remains high, particularly in patients with septic thrombosis of the cavernous (30%) and superior sagittal (78%) sinuses.
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PMID:Septic thrombosis of the dural venous sinuses. 351 53

Nine hundred seventy cases of childhood bacterial meningitis treated at 107 institutions in Japan from 1979 through 1984 were studied using questionnaire. The number of cases that underwent antimicrobial monotherapy remained nearly constant during the study period, but cases of therapies with beta-lactam combined with aminoglycosides (AGs) decreased in number and a gradual increase in the use of beta-lactam combined with non-AGs antibiotics including beta-lactam (Non AGs) was observed. A trend showing decrease in case fatality rate (CFR) was observed except that CFR for Gram-positive bacterial infections treated with beta-lactam + AGs remained at a same level. Cases treated with antibiotics were classified into 3 groups according to major etiological pathogens. Cases with Staphylococcus aureus gave a poor prognosis, among 27 total cases, CFR was 28.6% (2/7) with monotherapy, 50.0% (6/12) with beta-lactam + AGs and 37.5% (3/8) with beta-lactam + Non AGs (P less than 0.1). Among 100 cases of group B Streptococcus (GBS), CFR was 20.0% as a whole, 17.3% (9/52) for monotherapy and 34.5% (10/29) for beta-lactam + AGs (P less than 0.1). Among 198 cases of Streptococcus pneumoniae, CFR was 12.1% as a whole, and was 12.3% (18/146) with monotherapy. CFR for the cases treated with beta-lactam + AGs was 20.8% (5/24) and with beta-lactam + Non AGs was 3.6% (1/28) (P less than 0.1). CFR for 292 cases of Haemophilus influenzae meningitis was fairly low, and was 6.1% (9/148) with monotherapy, 7.4% (5/68) with beta-lactam + AGs and 3.9% (3/76) with beta-lactam + Non AGs, thus very slight differences were observed among the 3 groups of treatment. Among 111 cases of Escherichia coli, monotherapy and beta-lactam + Non AGs gave 6.5% (2/31) CFR, and 5.6% (1/18) CFR, respectively, whereas beta-lactam + AGs showed CFR of 19.4% (12/62), demonstrating a significant difference tendency (P less than 0.1). Similar tendencies were observed in the cases of Listeria monocytogenes, Proteus mirabilis, Pseudomonas aeruginosa and Enterococcus faecalis. Contrary to the high CFR observed with the beta-lactam + AGs treatment, significantly low CFR was frequently obtained in cases treated with a combination of penicillins with cephalosporins including latamoxef or beta-lactam with chloramphenicol. Infections with GBS, E. coli, and P. mirabilis occurred largely in the age between 0 to 6 months and CFR was especially high in the very young.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Recent trend of childhood bacterial meningitis in Japan (1979-1984). Part 4. A classification of prognosis and antibiotic treatment based on causative agents]. 361 93

Central nervous system (CNS) infections in immunocompromised hosts are often accompanied by subtle disorders because immunosuppression usually decreases the inflammatory response. CNS infections in immunocompromised patients are usually caused by organisms different from those found in the general population. The organism causing CNS infection in an immunocompromised host can often be predicted if the type of immune abnormality of the patient is known. The common causes of CNS infection in immunocompromised hosts are reviewed here. Meningitis in patients with neutropenia is usually due to enteric Gram negative bacilli that live in the patient's own digestive tract. Pseudomonas aeruginosa is most common and is followed by E. Coli, Klebsiella, Enterobacter and Proteus. A major risk in patients with abnormal immunoglobulins or splenectomy is infection with encapsulated bacteria, particularly Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. Meningitis caused by any of the encapsulated bacteria can be fulminant. Listeria monocytogenes is the most common cause of bacterial meningitis in patients with impaired cellular immunity. Nocardia asteroides is a leading cause of brain abscess in patients with hematologic malignancy. Most patients have evidence of concomitant pulmonary lesions. Fungi are among the most common organisms involving the CNS in immunocompromised hosts. Susceptible patients include those with lymphoma or leukemia and those who receive therapies aimed at suppressing delayed hypersensitivity. Cryptococcus neoformans is a common fungal cause of CNS infection in immunocompromised hosts. The primary site of infection is the lung. Spread to the CNS is via the blood stream. The clinical course is highly variable: meningitis, meningoencephalitis and focal mass lesions. Candida causes meningitis or meningoencephalitis characterized by multiple small abscesses in neutropenic hosts. Organisms reach the CNS via the blood stream usually from the digestive tract or infected intravenous catheters. Aspergillus causes brain abscess, cerebral infarction and focal meningitis in patients with neutropenia. The primary infection is in the lung. The parasites that infest the CNS of immunocompromised patients are usually those that exploit a T-lymphocyte, mononuclear phagocyte host defect. The most common are Toxoplasma gondii and Strongyloides stercoralis. There have been a few cases of amebiasis with dissemination to the brain in patients with hematologic malignancies. Toxoplasma gondii causes major CNS disease in immunocompromised hosts: meningoencephalitis or mass lesions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Infections of the central nervous system in malignant hemopathies]. 372 88

15 bacterial meningitis (Haemophilus: 7, Meningococci: 3, Proteus: 1, Enterobacter: 2, E. coli: 1 and Klebsiella: 1) are treated with moxalactam. The diffusion of moxalactam into the cerebrospinal fluid is good and regular. Excellent clinical results are obtained.
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PMID:[Value of moxalactam in the treatment of meningitis: efficacy and meningeal diffusion]. 622 24

Brain CT scans of 40 neonates with bacterial meningitis showed that the main lesions consisted of obstacles to CSF flow resulting in hydrocephalus during the second month; single or multiple foci of ischaemia of very early onset appearing as hypodense areas sometimes contrast-enhanced, and abscesses consecutive to haematogenous septic necrosis. The organisms responsible for these abscesses usually were Proteus spp., more rarely other enterobacteria. Attention is drawn to the usefulness of CT in detecting the nature and size of lesions which are often clinically silent, except for convulsions.
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PMID:[Scanography in purulent meningitis in newborn infants]. 622 58

Cefotaxime concentrations obtained in the C.S.F. of twelve children suffering from bacterial meningitis and undergoing monotherapy with this antibiotic are reported. Among these 12 patients, 4 infants (aged 3 to 28 days) had neonatal meningitis (due to Serratia marcescens, Proteus mirabilis, Enterobacter cloacae, Escherichia coli); one infant (2 months old) had meningitis due to Salmonella panama; 5 children (aged 5 to 11 months) had meningitis due to Haemophilus; and 2 children had belated superinfection caused by a ventriculo-peritoneal shunt due to Klebsiella pneumoniae and Pseudomonas aeruginosa. Cefotaxime concentration reached a high level as early as one hour after the injection (3 to 19 mcg/ml), remained at this level until the fifth hour (1,8 to 14,3 mcg/ml) and decreased without significant proportionality with the disappearance of the inflammatory symptoms. Compared to the M.I.C. of the bacteria which caused the twelve cases of meningitis, these results show that the concentrations in the C.S.F. are much higher than the M.I.C.'s. These results are comparable to those of previous studies. Cefotaxime diffuses in the C.S.F. and gives concentrations which ensures an antibacterial activity that ampicillin could not reach: in particular against Haemophilus influenzae and enterobacteriaceae.
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PMID:[Cefotaxime CSF levels in children with purulent meningitis (author's transl)]. 625 96

In an eight year period (1972-1979), 158 cases of enteric gram-negative bacillary meningitis and 53 cases of Listeria meningitis were reported to the New York City Health Department. These two forms of bacterial meningitis were the fourth and fifth most common ones reported to the Department, respectively. The cumulative total of reported cases of gram-negative rod meningitis over this less than the reported cases due to Neisseria meningitis over this period. In contrast to most previous studies of Listeria and enteric gram-negative meningitides, the majority of cases occurred in adults. Listeria meningitis occurred more often in immunosuppressed hosts and the elderly than in the newborn; gram-negative bacillary meningitides were seen more often in elderly septic patients and in patients with traumatic skull fracture than in infants during the first months of life. The over-all mortality of Listeria meningitis was 62 percent; that of the combined gram-negative meningitides 71.3 percent. The mortality in adults with Escherichia coli and Klebsiella meningitis who were treated with chloramphenicol as the major antibiotic was 83 percent. In comparison, the only appreciable survival rates noted were in those with Listeria, Escherichia coli, Proteus mirabilis and Salmonella meningitis who were treated with ampicillin alone in whom the over-all mortality was 51 percent.
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PMID:Listeria and gram-negative bacillary meningitis in New York City, 1972-1979. Frequent causes of meningitis in adults. 702 Apr 16

Meropenem and imipenem are carbapenems which are distinguishable from all other currently available beta-lactam antibiotics by breadth of antibacterial spectrum and stability to beta-lactamases, but can be differentiated one from another. Meropenem is relatively stable to human renal dehydropeptidase-I (DHP-I); it does not require to be co-administered with cilastatin and consequently, unlike imipenem, will be administered as a single agent. In vitro both meropenem and imipenem are active against almost all clinically important aerobic and anaerobic bacteria. Differences in potency are seen but few may be of clinical significance: imipenem is more active against enterococci and meropenem is more active against Pseudomonas aeruginosa, Pseudomonas cepacia, Haemophilus influenzae and Proteus, Morganella and Providencia species. The primary target of imipenem is PBP2 in P. aeruginosa whilst meropenem has high affinity for both PBP2 and 3; this may contribute to greater potency against this organism. Laboratory evaluations predict that meropenem will not be seizurogenic, which combined with activity against likely pathogens, identified its potential for the treatment of bacterial meningitis. This has been investigated in a guinea-pig model in which meropenem exhibited potent activity against the common meningeal pathogens and also infections caused by penicillin-resistant Streptococcus pneumoniae or Listeria monocytogenes. Clinical experience will determine the significance of these differences.
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PMID:Laboratory data which differentiate meropenem and imipenem. 765 4

A 6 year-old child was admitted for a recurrent bacterial meningitis at Proteus Morganii. She was treated with antibiotics. The C.T. Scanner showed a midline low-density lesion, with a mild annular contrast uptake in the posterior fossa. M.R.I. showed the lesion and revealed a skin-bone-dura fistula. The surgical resection was complete. It was an epidermoid tumor. Intracranial epidermoid tumors constitute about 1% of brain tumors and are considered to be congenital. Epidermoid tumors of the 4th ventricle are exceedingly rare in childhood. The authors reviewed the literature and discuss the pathogeny, the radiographic diagnosis and the treatment of these tumors.
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PMID:[Epidermoid cyst of the 4th ventricle. Apropos of a case in a child and review of the literature]. 820 32


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