1/24. ciprofloxacin in treatment of nosocomial meningitis in neonates and in infants: report of 12 cases and review.Twelve cases of neonatal and infant nosocomial meningitis treated with intravenous ciprofloxacin in doses of 10 to 60 mg/kg/day are described. Four neonates were 21 to 28 days old and eight infants were 2 to 6 months old. Six presented with Gram-negative meningitis: escherichia coli (2), salmonella enteritidis (1), acinetobacter calcoaceticus (1), two with two organisms, and (H. influenzae plus staphylococcus epidermidis, Acinetobacter spp. plus S. epidermidis), and six were attributable to gram-positive cocci (four S. aureus and two enterococcus faecalis). Ten cases were cured. In two cases, reversible hydrocephalus appeared that responded to intraventricular punctures. In seven children, no neurologic sequellae appeared after a 2- to 4-year follow-up. One neonate had relapse of meningitis 3 months later and was ultimately cured, but developed a sequellae of psychomotoric retardation. Follow-up varied from 27 months to 10 years. Current published case reports from medline on quinolone use in meningitis in neonates and infants are reviewed.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/24. Polymicrobial meningitis revealing an anterior sacral meningocele in a 23-year-old woman.Polymicrobial meningitis has become increasingly rare during recent decades. Historically, it has mainly been reported as being associated with disorders of the ENT-sphere. The treatment of these infections being optimized, polymicrobial meningitis nowadays is essentially a complication of gastrointestinal or gynaecological disorders and trauma. We present a case of polymicrobial meningitis following puncture of a unrecognized pre-sacral meningocele in a patient with Currarino syndrome and review of the relevant literature.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/24. Kingella endocarditis and meningitis in a patient with SLE and associated antiphospholipid syndrome.We describe a patient with SLE and antiphospholipid syndrome who presented with severe headache and fever. Lumbar puncture analyses indicated meningitis. kingella kingae was isolated from her blood cultures. A large mobile vegetation was seen on her mitral valve. The association between SLE, Libman-Sacks endocarditis and bacterial endocarditis is discussed.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/24. citrobacter sepsis and severe newborn respiratory failure supported with extracorporeal membrane oxygenation.An infant with fulminant citrobacter sepsis and respiratory failure is presented. The severity of respiratory failure and the need for systemic heparinization on extracorporeal membrane oxygenation delayed the opportunity of initial lumbar puncture to rule out meningitis. The infant was successfully treated with extracorporeal membrane oxygenation and long-term antibiotics. Repeated cranial computed tomography scans remained negative for intracerebral abscesses, and the infant is within normal limits for growth, neurologic status, and developmental status.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/24. Iatrogenic meningitis: an increasing role for resistant viridans streptococci? Case report and review of the last 20 years.Iatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. cerebrospinal fluid cultures grew streptococcus salivarius partially resistant to penicillin and ceftriaxone. The patient was successfully treated with ceftriaxone and vancomycin and left the hospital with minor sequelae. A literature review of 60 cases revealed the median age of the patients to be 44 y. The median incubation period was 24 h. Most cases occurred after spinal anaesthesia (n = 27), myelography (n = 20) and diagnostic lumbar puncture (n = 5). Organisms were isolated in 52 cases, and streptococcal species were responsible for 33 (63%) of them. An upward trend in resistance of S. viridans isolates is cause for concern and may change empirical treatment strategies. death was reported in 3 cases (5%) and was associated with pseudomonas and staphylococcal isolates. The recognition of this entity and the importance of proper infection control measures are underlined.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
6/24. Intracranial vasculitis and multiple abscesses in a pregnant woman.Cerebral vasculitis is an unusual disorder with many causes. Infectious causes of cerebral vasculitis are predominantly bacterial or viral in nature. Purulent bacterial vasculitis is most often a complication of severe bacterial meningitis. The patient is a 25-year-old African American female, 25 weeks pregnant, who presented to the neurology service after a consult and referral from an outside hospital. She had a 1-month history of right sixth nerve palsy. Initial workup included a negative lumber puncture and a noninfused magnetic resonance imaging (MRI). Three days later, the patient developed right-sided migraine headaches and right third nerve palsy. The angiogram revealed diffuse irregularity and narrowing of the petrous, cavernous, and supraclinoid portions of the internal carotid and right middle cerebral arteries. Shortly thereafter, an MRI examination revealed diffuse leptomeningeal enhancement and abscess and a right parietal subdural empyema. Infectious vasculitis secondary to purulent meningitis has a rapidly progressive course and presents with cranial nerve palsy with involvement of the cavernous sinus. Although the association of this disease with pregnancy has not been established, it should be recognized that the early imaging studies may be negative or discordant and follow-up imaging might be necessary.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/24. Pneumoencephalomeningitis secondary to infected lumbar arthrodesis with a fistula: a case report.pneumocephalus associated with spinal problems is very rare. association with encephalomeningitis secondary to a fistula after an infected elective lumbar spine fusion has not been previously reported. The authors report a case in which the clinical onset of pneumoencephalomeningitis occurred after an airplane flight. CT-scan and lumbar puncture were used to make diagnosis; the treatment was based on parenteral antibiotics. The symptoms and signs of infection and neurological deficit resolved but the fistula remained. diagnosis in such cases must be based upon CT-scan and lumbar puncture. Treatment should consist of systemic antibiotic therapy. Surgical management of infection and fistula is desirable, should the status of the patient allow such a treatment. In any case, as airplane flights in such cases may predispose to pneumocephalus, patients with an infected CSF fistula should avoid airplane flights until the problem is solved.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
8/24. Neurogenic pulmonary oedema induced by bacterial meningitis: a case report.We report a case of neurogenic pulmonary oedema occurring in association with bacterial meningitis. An 87 year old man suddenly developed severe dyspnoea without cardiac failure (MUGA scan ejection fraction 47%). Radiographs showed pulmonary oedema. A few hours later he developed signs of meningitis and lumbar puncture suggested a partially treated bacterial meningitis. We suspect that the bacterial meningitis had induced neurogenic pulmonary oedema.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/24. Actinomycotic meningitis: report of a case.A 73-year-old man who presented with acute fever, drowsiness and confusion was reported. Two weeks prior to admission, he attended the Outpatient Department with symptoms of fever and headache for 2 weeks. Eosiophilic meningitis was initially diagnosed, which, in fact, was lymphocytic CSF pleocytosis. He was treated with a high dose of prednisolone. His symptoms improved for 1 week, then he experienced symptoms of fever and headache again. On admission, he had stiffness of the neck. Lumbar puncture showed purulent CSF with gram-positive branching filamentous organisms. CSF grew actinomyces israelii. The patient died from brain herniation.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/24. epidural abscess and meningitis after epidural corticosteroid injection.epidural abscess with and without associated meningitis after epidural corticosteroid injections for radicular back pain is a rarely reported complication. We report the occurrence of an epidural abscess and meningitis in a 70-year-old man after 2 epidural corticosteroid injections for treatment of acute radicular lumbar back pain. At the time of diagnosis, cerebrospinal fluid cultures grew staphylococcus aureus, and the patient was treated with intravenous antibiotics. Possible predisposing factors for the development of an epidural abscess and meningitis in this patient include a 2-year history of neutropenia and an accidental dural puncture that occurred during performance of the first epidural injection. A literature search identified 11 reported cases of epidural abscess, 2 of epidural abscess and meningitis, and 1 of meningitis attributed to epidural corticosteroid injections. Eight of the 14 reported patients were immunocompromised, and 8 (67%) of the 12 in whom cultures of blood, cerebrospinal fluid, or epidural pus were performed had results positive for S. aureus. antibiotic prophylaxis for S. aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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