11/18. Meningopolyneuritis Bannwarth with focal nodular myositis. A new aspect in Lyme borreliosis.A patient with serologically confirmed infection by borrelia burgdorferi presenting with painful paresis and atrophy of the proximal muscles of both upper extremities and bilateral facial paresis is described. electromyography showed a neurogenic and myopathic pattern, and creatine kinase was raised. Muscle biopsy revealed the typical signs of focal myositis. Treatment with i.v. penicillin led to dramatic clinical and serological improvement. Muscle biopsy was repeated 2 months later; neurogenic changes were still present, but no inflammatory signs could be seen anymore. Thus, the presented case may be the first reported of meningopolyneuritis accompanied by focal nodular myositis, in the second stage of Lyme borreliosis.- - - - - - - - - - ranking = 1keywords = burgdorferi (Clic here for more details about this article) |
12/18. Demonstration of uronic acid capsular material in the cerebrospinal fluid of a patient with meningitis caused by mucoid pseudomonas aeruginosa.A 39-year-old female with insulin-dependent diabetes mellitus developed rhizopus infection of the maxillary sinus. Subsequent to successful treatment with amphotericin b and surgical debridement, she developed purulent meningitis due to a mucoid strain of pseudomonas aeruginosa. Analysis of cerebrospinal fluid documented the presence of a uronic acid polymer at a concentration of 40 micrograms/ml. In spite of parenteral and intrathecal antibiotic therapy, the patient died. This case illustrates that mucoid strains of P. aeruginosa may result in fatal infection and that alginate capsule is produced in vivo in humans.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
13/18. Chronic hypertrophic cranial pachymeningitis associated with HTLV-I infection.Two patients presenting with recurrent multiple cranial neuropathy showed diffuse thickening and gadolinium enhancement of the dura mater on brain MRI. Both had anti-htlv-i antibodies in serum. A quantitative polymerase chain reaction study of the peripheral blood disclosed that the HTLV-I proviral dna loads increased considerably in one case and moderately in the other. Both showed a spontaneous proliferation of peripheral blood lymphocytes as well as an increase in helper/inducer T cells. Neither had any other underlying infections or autoimmune diseases. Thus it is possible that hypertrophic pachymeningitis developed as a result of multiorgan involvement of HTLV-I infection in these patients.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
14/18. herpes simplex virus type 2 meningitis in the absence of genital lesions: improved recognition with use of the polymerase chain reaction.herpes simplex virus type 2 (HSV-2) is known to cause aseptic meningitis, which can be recurrent. The diagnosis of HSV-2 infection is suggested when meningitis occurs simultaneously with genital lesions but may be obscure if genital lesions are not present or are not appreciated. Viral culture of the CSF is sometimes positive, but it may also be negative, especially in cases of recurrent disease. We report three cases of HSV meningitis in young women who did not have a history of genital herpetic lesions and for whom genital lesions were not noted on presentation. With use of the polymerase chain reaction (PCR), HSV dna was detected in CSF from all three patients. The diagnosis of HSV meningitis was further confirmed by a positive culture of CSF in one patient's case and by demonstration of intrathecal synthesis of HSV antibodies in a second patient's case. The use of PCR can improve the recognition of HSV meningitis in adults presenting with aseptic meningitis, even in the absence of herpetic lesions.- - - - - - - - - - ranking = 0.024776994189181keywords = lyme (Clic here for more details about this article) |
15/18. brain abscess due to infection with entamoeba histolytica.We successfully treated a serious case of entamoeba histolytica infection showing brain abscess, meningitis, and liver abscess by oral administration of metronidazole, intramuscular injection of dehydroemetine, and drainage of the brain abscess. The diagnosis of amebic brain abscess was based on a combination of clinical symptoms and signs, computed tomography and magnetic resonance imaging findings, a positive serologic test result for E. histolytica, a dramatic response to anti-amebic drugs after an ineffective therapeutic history with antibacterial drugs, and application of the polymerase chain reaction method.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
16/18. prognosis and response to therapy of cytomegalovirus encephalitis and meningomyelitis in AIDS.Effective diagnosis and treatment of cytomegalovirus infection of the nervous system in AIDS patients has been limited by a lack of sensitive diagnostic measures. Retrospective series suggest a poor prognosis for cytomegalovirus encephalitis with rapid mortality. polymerase chain reaction amplification of cytomegalovirus dna allows detection in CSF that appears specific for CNS infection. In this series of seven patients with CNS cytomegalovirus infection in AIDS, four patients responded to therapy. Serial determinations of cytomegalovirus dna in CSF in five patients revealed persistent detection in two treatment failures and absence of detection in three responders on subsequent CSF samples. A prospective trial to determine optimal therapy and to confirm the utility of cytomegalovirus dna in CSF as a marker of the course of cytomegalovirus infection in the CNS is warranted and should consider prior therapy for cytomegalovirus, prior opportunistic infections, and leukoencephalopathy as potential prognostic variables.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
17/18. Successful treatment of atypical mycobacterial meningitis by fluoroquinolone.We report a case of restricted meningeal infection by atypical mycobacteria, identified by the polymerase chain reaction, in a non-immunocompromised adult successfully treated by multiple antibiotics including fluoroquinolone. New quinolones should be considered as a therapeutic option for such mycobacterial meningitis.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
18/18. Encephalomyeloradiculopathy associated with Epstein-Barr virus: primary infection or reactivation?INTRODUCTION: Encephalomyeloradiculopathy (EMR) is a new syndrome, characterized by extensive involvement of the nervous system at different levels, including brain, medulla and spinal roots. We describe a patient presenting with prodromal febrile illness, followed by a wide infection of the nervous system with transverse myelitis and less severe meningitis, encephalitis and polyradiculopathy. The patient was treated with high-dose corticosteroids, antibiotics and acyclovir; in spite of therapy his condition improved very slowly, with severe neurological sequelae. MATERIAL AND methods: Antiviral antibodies were searched for in serum and cerebrospinal fluid (CSF) by commercially available ELISA kits. Viral investigations were performed by cell culture isolation and search for viral antigens, and genomic nucleic acids were investigated by polymerase chain reaction (PCR). RESULTS: Virological and serological studies evidenced a primary infection by cytomegalovirus (CMV), possibly responsible for the prodromal illness, persisting in the course of the disease. PCR performed in the peripheral blood mononuclear cells (PBMCs), dna collected early and in the CSF drawn 30 days after the onset of the disease showed Epstein-Barr virus (EBV) dna. The serum panel of EBV antibodies was typical of an intercurrent virus reactivation, more than of a primary infection. CONCLUSION: EBV is known to be highly infectious for the nervous system, in this case of EMR the presence of dna sequences in the PBMCs and CSF suggests that EBV plays a role in the development of this newly described syndrome.- - - - - - - - - - ranking = 0.0049553988378362keywords = lyme (Clic here for more details about this article) |
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