1/7. Group a streptococcal meningitis in adults: report of 41 cases and a review of the literature.Chart review of 41 adult patients with group A streptococcal (GAS) meningitis in The netherlands revealed that this is a community-acquired disease and occurs mainly in patients with predisposing factors: of the 41 patients in this case series, 24 (60%) of 40 evaluable patients had otitis or sinusitis. fever and neck stiffness were the most common clinical manifestations of disease, but, in addition, high rates of seizures (12 [32%] of 38 patients), focal neurological findings (13 [36%] of 36 patients), and hyponatremia (20 [58%] of 35 patients) were found. In contrast with data from the literature that describes 27 adult cases, we found that GAS meningitis is a fulminant disease with a mortality rate of 27% (10 of 37 patients), and that neurological sequelae occur in 36% (12 of 38) of surviving patients.- - - - - - - - - - ranking = 1keywords = otitis (Clic here for more details about this article) |
2/7. Recurrent pneumococcal meningitis in homozygous C3 deficiency.Congenital deficiencies of complement system proteins are rare. A 4-year-old girl was admitted for meningitis. She had had repeated attacks of pneumococcal meningitis and otitis media at the age of 3 years. Analysis of cerebrospinal fluid showed that this meningitis was due to pneumococcal infection. Complement 3 and CH50 values of the proband and her brother were low, while her parents were normal. The patient was given polyvalent pneumococcal and anti-haemophilus vaccines plus ceftriaxone. Recovery was complete after 15 days of antibiotic therapy. This is the first description of a case of recurrent meningitis with C3 and CH50 deficiency in a Turkish family.- - - - - - - - - - ranking = 1keywords = otitis (Clic here for more details about this article) |
3/7. Complement component deficiencies and infection: C5, C8 and C3 deficiencies in three families.Three families are described with complement component deficiencies. In one family, five children had C5 deficiency; in a second family, two children had C8 deficiency and one child in a third family had C3 deficiency. The index cases were identified during screening of patients with recurrent pyogenic infections, recurrent meningitis and meningococcaemia. Two of the five C5 deficient patients had recurrent meningitis and meningococcaemia, two had recurrent respiratory tract infections and otitis and one was healthy. One of the C8 deficient patients had meningitis, meningococcaemia and pneumonia, whereas his sibling with the same deficiency was healthy. The patient with C3 deficiency had four episodes of meningitis and recurrent otitis.- - - - - - - - - - ranking = 2keywords = otitis (Clic here for more details about this article) |
4/7. Late posttraumatic meningitis with concealed CSF otorrhea.An 11-year-old girl with repeated pneumococcal meningitis after head injury is reported. High resolution CT scan with metrizamide cisternogram disclosed a fracture in petrous bone with collection of contrast medium in middle ear. Operative repair of the dura defect successfully stopped further intracranial infection. In cases of late posttraumatic infection, aggressive survey of the skull base is indicated.- - - - - - - - - - ranking = 0.052141627529881keywords = medium (Clic here for more details about this article) |
5/7. Recurrent meningitis due to pneumococci and non-typable haemophilus influenzae in a child with a Mondini malformation.An eight-year-old boy with a congenital inner ear malformation and recurrent otitis media had three episodes of bacteriologically confirmed meningitis within seven months. The first episode was caused by pneumococci, the other two by non-typable haemophilus influenzae. All episodes were characterized by an abrupt onset. The CSF cultures were positive within 0.5 to 12 hours after the onset of symptoms. Despite misleading laboratory studies, surgical exploration revealed a CSF fistula associated to the inner ear anomaly. No further episodes occurred after the fistula was closed. Careful roentgenographic evaluation, including recently introduced special computed tomography (CT) methods, is indicated in recurrent meningitis. In addition, such evaluations should be considered even after the first episode, when special clinical features suggest a CSF fistula. Such features include an extremely rapid onset and detection of common non-invasive bacteria as causative agents, as illustrated by the present case.- - - - - - - - - - ranking = 1keywords = otitis (Clic here for more details about this article) |
6/7. subarachnoid space: middle ear pathways and recurrent meningitis.Congenital bony abnormalities of the inner ear may result in a communication between the middle ear and the subarachnoid space. patients with this anomaly often present with recurrent meningitis associated with acute otitis media or with middle ear fluid. This article presents three cases of recurrent meningitis with open middle ear--subarachnoid space connections. The first two cases involve a cerebrospinal fluid leak into the middle ear via the oval window, both patients having a Mondini-type of inner ear deformity. The pathway in the third case opened into the middle ear along the horizontal portion of the facial nerve. Computed tomography (CT) scanning with metrizamide and differential density calculations helped to identify the abnormal pathway and to confirm that the leak has been closed postoperatively. Use of the CT scanner in these cases can be helpful in planning the surgical closure and in postoperative follow-up.- - - - - - - - - - ranking = 1keywords = otitis (Clic here for more details about this article) |
7/7. Poststapedectomy otitis media and meningitis.A patient developed acute otitis media, labyrinthitis, and meningitis 16 months after a stapedectomy operation, and 14 similar cases have been collected from the literature. Poststapedectomy otitis media carries an increased risk of labyrinthitis and meningitis and requires prompt antibiotic therapy and regular observation until cured. Should labyrinthitis occur, with or without meningitis, fistula repair must be undertaken as soon as the infection is eliminated. All stapedectomy patients require regular supervision, and must report for urgent treatment if symptoms of otitis media or perilymph fistula occur. Stapedectomy techniques should not employ sharp bevelled prostheses, and autogenous tissue grafts are probably superior to an absorbable gelatin sponge in protecting the inner ear. eustachian tube problems and recurring or chronic upper-respiratory tract infections can predispose to middle ear infection and are thus contraindications to stapedectomy.- - - - - - - - - - ranking = 7keywords = otitis (Clic here for more details about this article) |