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

Corticosteroids were proposed to treat patients with severe sepsis as early as 1940. A summary of all available randomized controlled trials performed between 1966 and 1993 was provided in two systematic review that recommended to abandon the use of high dose coricosteroids to treat patients with severe infection. Nonetheless, a doubt still persist regarding the efficacy of a strategy of replacement therapy in cathecolamines-dependent shock. This strategy relies mainly on the concept that septic shock may be complicated by 1) an occult adrenal insufficiency, 2) a glucocorticoid peripheral resistance syndrome. Some studies demonstrated the effect of replacement therapy with hydrocortisone on the sistemic inflammatory response and on the cardiovascular function during sepsis. The effect of this therapy on survival to septic shock is controversial both in recent and old studies. Finally a recently completed multicenter, placebo controlled, randomized, double-blind study has evaluated the efficacy and tolerance of a replacement therapy with a combination of hydrocortisone (50 mg intravenous bolus four times per day) and fludrocortisone (50 g orally once a day) given for 7 days. This study included 300 catecholamines- and ventilator-dependent septic shock. The authors found a significant reduction in 28-day mortality in patient with occult renal insufficiency. In sum, short course with high doses of corticosteroids should not be given in severe sepsis, except for specific entitles like severe typhoid fever, pneumocystis carinii pneumonia in AIDS or bacterial meningitis in children. The rational for a replacement therapy with hydrocortisone in catecholamines-dependent septic shock grows stronger.
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PMID:Resurrection of steroids for sepsis resuscitation. 1202 69

The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.
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PMID:[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon]. 1677 41

Certain arthropod-borne infections are common in tropical regions because of favorable climatic conditions. Water-borne infections like leptospirosis are common due to contamination of water especially during the monsoon floods. Infections like malaria, leptospirosis, dengue fever and typhus sometimes cause life threatening organ dysfunction and have several overlapping features. Most patients present with classicial clinical syndromes: fever and thrombocytopenia are common in dengue, malaria and leptospirosis; coagulopathy is frequent in leptospirosis and viral hepatitis. Hepatorenal syndrome is seen in leptospirosis, falciparum malaria and scrub typhus. The pulmonary renal syndrome is caused by falciparium malaria, leptospirosis, Hantavirus infection and scrub typhus. Fever with altered mental status is produced by bacterial meningitis, Japanese B encephalitis, cerebral malarial, typhoid encephalopathy and fulminant hepatic failure due to viral hepatitis. Subtle differences in features of the organ failure exist among these infections. The diagnosis in some of these diseases is made by demonstration of antibodies in serum, and these may be negative in the first week of the illness. Hence empiric therapy for more than one disorder may be justified in a small proportion of cases. In addition to specific anti-infective therapy, management of organ dysfunction includes use of mechanical ventilation, vasopressor drugs, continuous renal replacement therapy and blood products. Timely transfer of these patients to well-equipped ICUs with experience in managing these cases can considerably decrease mortality and morbidity.
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PMID:Tropical infections in the ICU. 1694 13

Fever after travel to sub-tropical and tropical areas opens a wide door of differential diagnoses. Apart from the entire scope of internal medicine, unrelated (first manifestation of a plethora of disorders) or related to travel (e.g. pulmonary embolism in a risk patient), there are emergency and non-emergency infectious causes to be considered. Bacterial meningitis or other causes of septicaemia (Pyelonephritis, Pneumonia), severe bacterial infections of the intestines and amoebic liver abscess, typhoid fever, and viral haemorrhagic fevers should always be considered. Malaria must be ruled out if the patient has travelled in an endemic area within the past 3-12 months. A thorough history and a meticulous physical examination, the use of an electronic support (e.g. www. fevertravel.ch) and basic laboratory investigations (malaria blood slide, Hb. Differential WBC, platelets, stool culture, urine analysis, selective cultures and serologies), if necessary with the help of expert advice from a specialist in tropical and infectious diseases are elements for a successful establishment of a meaningful differential diagnosis.
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PMID:[Practical aspects on fever in returning travellers]. 1704 87

Clinicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.
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PMID:Use of corticosteroids in treating infectious diseases. 1850 31

The need for reliable, fast diagnostics is closely linked to the need for safe, effective treatment of the so-called "neglected" diseases. The list of diseases with no field-adapted diagnostic tools includes leishmaniasis, shigella, typhoid, and bacterial meningitis. Leishmaniasis, in particular, is a parasitic disease caused by Leishmania spp. transmitted by infected phlebotomine sandfly, which remains a public health concern in developing countries with ca. 12 million people infected and 350 million at risk of infection. Despite several attempts, methods for diagnosis are still noneffective, especially with regard to specificity due to false positives with Chagas' disease caused by Trypanosoma cruzi . Accepted golden standards for detecting leishmaniasis involve isolation of parasites either microscopically, or by culture, and in both methods specimens are obtained by invasive means. Here, we show that efficient distinction between cutaneous leishmaniasis and Chagas' disease can be obtained with a low-cost biosensor system made with nanostructured films containing specific Leishmania amazonensis and T. cruzi antigens and employing impedance spectroscopy as the detection method. This unprecedented selectivity was afforded by antigen-antibody molecular recognition processes inherent in the detection with the immobilized antigens, and by statistically correlating the electrical impedance data, which allowed distinction between real samples that tested positive for Chagas' disease and leishmaniasis. Distinction could be made of blood serum samples containing 10(-5) mg/mL of the antibody solution in a few minutes. The methods used here are generic and can be extended to any type of biosensor, which is important for an effective diagnosis of many other diseases.
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PMID:Biosensors for efficient diagnosis of leishmaniasis: innovations in bioanalytics for a neglected disease. 2104 37

Vaccine-preventable diseases (VPDs) are costly at both the individual and societal levels. The most common VPDs recorded in travellers are enteric (typhoid or paratyphoid B) fever, acute viral hepatitis, influenza, varicella, measles, pertussis and bacterial meningitis. Travellers suffering from VPDs are frequently hospitalized, illustrating the point that VPDs are serious and expensive. Many travellers are not properly immunized before travel. In addition to individual consequences, VPDs can have public-health consequences if they are introduced or re-introduced by infected travellers returning to areas with susceptible populations. The international spread of poliomyelitis, Neisseria meningitidis serogroup W135 meningococcal infections, measles and influenza provides strong evidence of the role of international travel in the globalization of VPDs. The surveillance of the emergence, re-emergence or spread of VPDs is essential to adapt pre-travel advice and the responses to the VPD.
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PMID:The spread of vaccine-preventable diseases by international travellers: a public-health concern. 2286 65


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