Biomedical subjects

Chen-Sheng Chang

Publications and source records attributed to Chen-Sheng Chang.

15 recordsLinked to original sources

PubMed2005

Adult Streptococcus pneumoniae meningitis in Southern Taiwan: epidemiologic trends and prognostic factors.

The clinical features of 22 adult patients with Streptococcus pneumoniae meningitis, retrospectively collected over a 16-year period, were reviewed. Otopharyngeal infection, haematogenous spread and cranial neurosurgery continue to be the predominant routes of infection. Most patients acquired the infection in the community, and predisposing underlying conditions are common. The proportion of S. pneumoniae meningitis compared to all microorganisms causing meningitis in adults declined dramatically from 17% in the first 8 study years to 4% in the last 8 study years. However, all penicillin-resistant S. pneumoniae strains were found in the second half of the study period, accounting for 25% of these episodes. The overall mortality rates for the first and second halves of the study period were 43% and 63%, respectively. Third-generation cephalosporins were the antibiotics of choice for the treatment of S. pneumoniae meningitis in this study, however, the emergence of resistant strains may create a therapeutic challenge in the future. To avoid treatment failure, early diagnosis, careful monitoring of the clinical course and the choice of appropriate antibiotics according to the in vitro antimicrobial susceptibilities, are necessary.

Adolescent↗

PubMed2005

Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes.

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.

Adolescent↗

PubMed2005

Mah-Jong-induced epilepsy: a special reflex epilepsy in Chinese society.

We present five patients of epilepsy in which seizures were triggered by playing or watching the traditional Chinese gambling game "Mah-Jong." One patient also experienced seizures while playing a computer version of the Mah-Jong game. This condition appeared to have a predominance of males (80%) and middle-aged onset (39.4 years). Four patients had generalized tonic-clonic seizures and one patient had partial seizures with secondary generalization. No spontaneous seizure occurred in these patients. Three patients had been receiving antiepileptic drug therapy, but without effective control over their seizures. Mah-Jong-induced epilepsy is a very peculiar form of complex reflex epilepsy that involves the higher mental activities. This phenomenon may consist of distinct pathophysiologic mechanisms from other reflex epilepsy induced by thinking and spatial tasks in idiopathic generalized epilepsies. This unusual reflex epilepsy is relatively benign in nature and antiepileptic drug therapy has uncertain benefits. It may be necessary to avoid playing the Mah-Jong game in order to prevent seizures.

Adult↗

PubMed2004

Seizures complicating infantile and childhood bacterial meningitis.

In this study, 116 patients, at least 1 month of age but younger than 5 years, were identified with culture-proven bacterial meningitis. A comparison was made between the clinical data of the patients with and without seizures during hospitalization. Seizures during acute bacterial meningitis accounted for 47% (55/116) of the episodes. Time interval between the onset of bacterial meningitis and that of seizures was 1 to 20 days (mean, 4 days). Twelve of these 55 patients had one or more afebrile seizures after completing the treatment. At follow-up of at least 1 year after completing treatment, 26 patients had good outcomes, whereas the other 29 patients had poor outcomes. A strong correlation between the findings of abnormalities through neuroimaging and the occurrence of seizures during hospitalization was observed. The long-term outcomes of patients with infantile and childhood bacterial meningitis, who had seizures during the acute phase of bacterial meningitis, were worse than the outcomes of those who did not have such seizures. No child developed late seizures unless there were acute seizures. Factors associated with seizures during acute bacterial meningitis include disturbed consciousness on admission, abnormal neuroimaging findings, and low glucose and high concentration of total proteins in cerebrospinal fluid.

Chi-Square Distribution↗

PubMed2004

Bacterial meningitis in infants: the epidemiology, clinical features, and prognostic factors.

This 16-year (1986-2001) retrospective study enrolled 80 infantile patients (aged, 30-365 days old) with culture-proven bacterial meningitis. The most prevalent pathogens were Salmonellaspecies, Streptococcus (S.) agalactiae, Escherichia (E.) coli, and Haemophilus (H.) influenzae, accounting for about 59% of the episodes. Meningitis caused by Salmonella species, E. coli and H. influenzae occurs more often in the older infants, while that caused by S. agalactiae occurs more often in young infants. Our study revealed a decrease in the proportion of Salmonella meningitis from 27% in the first 8 years to 9% in the second 8 years with E. coli replacing Salmonella species as the leading pathogen of this disease during the second period. Overall mortality rate for both periods of time was 11%. However, if we take those with undesirable poor outcomes into account, 43% of patients could be considered treatment failures. The study also reveals a high prevalence of neurological complications when this disease is caused by H. influenzae, S. pneumoniae, and Salmonella species. Stepwise logistic regression analysis revealed that only initial changing levels of consciousness (P = 0.006) were independently associated with treatment failure. The most frequent neurological complications associated with this disease included subdural empyema, hydrocephalus, cerebral infarctions, and seizures. Because therapeutic regimens may require attention to the eradication of bacterial pathogen but also the neurological complications, early diagnosis and choice of appropriate antibiotics are essential to increasing the possibility of survival.

Anti-Bacterial Agents↗

PubMed2004

A clinical and electrophysiologic survey of childhood Guillain-Barré syndrome.

In this 16-year (1986-2001) retrospective study, 23 childhood patients were identified with Guillain-Barré syndrome. According to clinical and electrophysiologic findings, 18 patients manifested acute inflammatory demyelinating polyradiculoneuropathy, 2 had Miller Fisher syndrome, 1 had axonal forms, and 2 were unclassified. Seasonal preponderance was evident in 39% of patients with Guillain-Barré syndrome, developing the disease in the winter (November to January) with upper respiratory infection the most frequent preceding event. The most common manifestation was limb weakness, with various degrees of motor weakness in 22 patients. Bulbar involvement was the most common cranial palsy, and it was evident in 30% of the episodes. Only one of these progressed to mechanical ventilation during hospitalization. Altogether, approximately 61% of the episodes exhibited sensory symptoms. At a follow-up of 1 year or more, 20 patients recovered and 3 had residua. Furthermore, no fatality occurred in our study. Our study also demonstrates that the clinical course of childhood Guillain-Barré syndrome has a shorter recovery time as compared with an adult patient group. Therapeutic outcome is favorable for patients who receive prompt treatment.

Adolescent↗

PubMed2004

Tooth-brushing epilepsy with ictal orgasms.

We report a 41-year-old woman with complex reflex epilepsy in which seizures were induced exclusively by the act of tooth brushing. All the attacks occurred with a specific sensation of sexual arousal and orgasm-like euphoria that were followed by a period of impairment of consciousness. Ictal EEG demonstrated two events of epileptic seizure that were provoked after tooth brushing for 38 and 14 seconds, respectively. The interictal EEG showed epileptiform discharges over the right anterior temporal region and interictal single photon emission computed tomography (SPECT) scan showed relative hypoperfusion in the uncus of right temporal lobe. Brain magnetic resonance imaging (MRI) revealed right hippocampal atrophy. We suggest that tooth-brushing epilepsy, especially with sexual ictal manifestations, may provide insight into the cerebral pathophysiology at the right temporolimbic structure.

Adult↗

PubMed2004

Predictive factors and long-term outcome of respiratory failure after Guillain-Barré syndrome.

OBJECTIVE: To analyze predictive factors and long-term recovery in patients with Guillain-Barré syndrome (GBS) who are in need of mechanical ventilation. METHODS: In this 15-year retrospective study, 77 adult patients were identified with GBS. A comparison was made between the clinical data from patients who required mechanical ventilation and those who did not. Furthermore, the therapeutic outcomes of those 25 patients in need of mechanical ventilation during hospitalization at 1 year were determined using a modified Barthel index. A score below 12 was defined as a poor outcome, whereas a score of 12 or more was good. RESULTS: The study revealed 32% of patients (25/77) in need of respiratory support during hospitalization. At a follow-up of 1 year among the 25 ventilated patients, 7 patients (28%) had normal or minor signs and symptoms, 6 had unassisted gait, 3 had assisted gait, 6 were wheelchair- or bed-bound, and 3 died. The cause of death was septicemia with septic shock in all 3 cases. Factors that predict respiratory failure in the study GBS patients were disability grade on admission and areflexia. Those ventilated patients who had low maximal inspiratory pressure (PImax) (<14.5 cmH2O) and maximal expiratory pressure (PEmax) (<13.5 cmH2O) values at the time of intubation and the presence of complications after mechanical ventilation inevitably had worse outcomes than those who had not. CONCLUSION: If low values of PImax and PEmax at intubation were detected, aggressive respiratory management, which might include tracheostomy to allow more efficient bronchial clearing, and prevention of complications caused by prolonged course of mechanical ventilation are essential to maximize the potential for survival.

Adolescent↗

PubMed2004

Infection of cerebrospinal fluid shunts: causative pathogens, clinical features, and outcomes.

This retrospective chart review describes the clinical features, pathogens, and outcomes of 46 patients with cerebrospinal fluid (CSF) shunt infections collected over 16 years. The overall CSF shunt infection rate was 2.1%, broken down into 1.7 and 9.3% in adult and pediatric groups, respectively. Fever and progressive consciousness disturbance were the most clinical features in the adult patient group, whereas disturbance of consciousness and abdominal symptoms and signs were the two most common clinical features in the pediatric patient group. The most frequently isolated microorganisms were of the Staphylococcus spp., including Staphylococcus aureus and coagulase negative Staphylococcus, which accounted for 47% of the episodes. Furthermore, increases in polymicrobial and Gram-negative bacilli infections were observed in our study. Due to the high proportion of oxacillin-resistant Staphylococcus spp. and polymicrobial infections, we recommend initial empirical antibiotics with both vancomycin and a third-generation cephalosporin for cases in which the causative bacteria has not been identified or for which the results of antimicrobial susceptibility tests are not available. For patients who develop smoldering fevers, progressive disturbed consciousness, seizures, or abdominal fullness after ventriculoperitoneal shunt procedures, CSF shunt infections should be suspected. Although some infections have been managed successfully with antimicrobial therapy alone, the timely use of appropriate antibiotics according to antimicrobial susceptibility testing and the removal of the shunt apparatus are essential for successful treatment.

Adolescent↗

PubMed2004

Serotypes of clinical cerebrospinal fluid Cryptococcus neoformans isolates from southern Taiwan and their in vitro susceptibilities to amphotericin B, fluconazole, and voriconazole.

In this study, 34 clinical cerebrospinal fluid isolates of Cryptococcus neoformans were serotyped, and their in vitro susceptibilities to amphotericin B, fluconazole, and voriconazole were analyzed. Of these 34 isolates, serotype A was found in 29 isolates and serotype B in the other five. The voriconazole geometric mean MIC was significantly lower than the amphotericin B/antibiotic medium 3 geometric mean MIC (P < 0.0001 at both 48 and 72 h), as well as the fluconazole geometric mean MIC (P < 0.0001 at both 48 and 72 h). Of the three antifungal agents, only fluconazole, with geometric mean MICs at both 48 and 72 h, showed significant difference between the serotypes A and B of C. neoformans.

Amphotericin B↗

PubMed2004

Cavernous sinus thrombosis and cerebral infarction caused by Fusobacterium nucleatum infection.

We report an unusual case of fusobacterial infection with secondary intracranial invasion. The condition was complicated by a cavernous sinus thrombosis and ischemic stroke. The patient was a 63-year-old woman with no history of systemic disease who had undergone a tooth extraction before the onset of symptoms. She initially suffered from sphenomaxillary sinusitis and a cavernous sinus thrombosis, and subsequently developed meningitis. Cerebrospinal fluid examination suggested a pyogenic infection. Anaerobic culture revealed Fusobacterium nucleatum. However, despite immediate antibiotic therapy, her condition remained unstable over the next few days, and she eventually developed an ischemic stroke. We describe our experience in the management of this case of anaerobic meningitis and the unusual complication of ischemic stroke; this case suggests that more aggressive therapy in addition to empirical antibiotics may be warranted.

Cavernous Sinus Thrombosis↗

PubMed2004

The finding and evaluation of EMG-guided BOTOX injection in cervical dystonia.

In this prospective study we report the results of EMG-guided BOTOX injections in a total of 15 cervical dystonia (CD) patients. Pre-treatment and post-treatment evaluations included physical examination results, Tsui ratings, and video recording. The dosage of BOTOX injection was determined by the EMG pattern, type of CD, and the degree of muscle hypertrophy. Seven patients underwent injections with and without EMG, and eight patients underwent injections with EMG-guidance only. The results showed that among the patients who underwent EMG-guided BOTOX injection there are: (1) fewer BOTOX-related side effects due to injection of the adequate dose of BOTOX to the accurate site of hyperactive muscles, (2) greater clinical improvement due to confirmation of hyperactivity in muscles in each type of cervical dystonia, (3) a better ability to reduce the amount of oral medication for treatment of muscle pain and spasms. We suggest that the use of EMG-guided BOTOX injections be considered for those CD patients with retrocollis, those who have had a sub-optimal treatment response to non EMG-guided BOTOX injections, and those with increased concern of side effects or a concomitant goal of reducing oral medications.

Botulinum Toxins, Type A↗

PubMed2004

An adult case of Chryseobacterium meningosepticum meningitis.

Chryseobacterium meningosepticum is an uncommon pathogen causing adult bacterial meningitis. Herein, we report the case history of one 21-year-old woman with this uncommon central nervous system infection. A diagnosis of adult C. meningosepticum meningitis can only be confirmed by a positive cerebrospinal fluid (CSF) culture. The patient had insulin-dependent diabetes mellitus as the underlying condition associated with this infection. The clinical presentations were fever, headache, consciousness disturbance, and seizure. CSF analysis revealed a purulent inflammatory reaction. After a 21-day course of intravenous cefepime (6 g/day) treatment, this patient was discharged in a state of complete recovery.

Adult↗

PubMed2003

Community-acquired spontaneous bacterial meningitis in patients with alcoholic liver disease.

BACKGROUND AND PURPOSE: Data on the clinical characteristics of adult alcoholic liver disease (ALD) patients with acute bacterial meningitis is limited. This study analyzed the clinical and laboratory data and therapeutic outcome of 14 men with ALD treated over a 15-year period. METHODS: Standardized forms were used to collect data from medical records of all adult patients with bacterial meningitis admitted to Chang Gung Memorial Hospital-Kaohsiung from January 1986 to December 2000. Data collected included microbiological records for cerebrospinal fluid, blood cultures, and all medical records. RESULTS: Three of the 14 patients with ALD had liver cirrhosis (2 with Child's class B and 1 with Child's class C). The causative pathogens of these 14 cases were Klebsiella pneumoniae in 11, Staphylococcus aureus in 2 and Enterococcus in 1. Diabetes mellitus (DM) was the most common underlying disease and was present in 64% of patients (9/14). All patients with DM had K. pneumoniae as the causative pathogen. Bacteremia and thrombocytopenia were found in 64% (9/14) and 50% (7/14) of the patients, respectively. Focal suppurations including brain abscess, intracranial subdural empyema, and cervical epidural abscess were found in 4 patients. The overall mortality rate was 14% (2/14). ALD accounted for 11.5% (14/122) of the underlying conditions of all adult cases of community-acquired spontaneous bacterial meningitis treated during the study period. CONCLUSIONS: There was a high incidence of K. pneumoniae infection in adult meningitis patients with ALD, especially those with concomitant DM.

Adult↗

PubMedDate not supplied

Bacterial meningitis in hemodialyzed patients.

BACKGROUND: To analyze the clinical features, causative pathogens and therapeutic outcomes of bacterial meningitis in hemodialyzed patients. PATIENTS AND METHODS: Two hundred and sixty-seven patients, > or = 16 yrs, were identified with culture-proven bacterial meningitis. In addition, the causative pathogens and therapeutic outcomes between uremic and non-uremic patients with adult bacterial meningitis were analyzed. RESULTS: Nine uremic patients with bacterial meningitis, accounting for 3% (9/267) of our adult patients with culture-proven bacterial meningitis had fever, disturbed consciousness and seizures. These were the three most common manifestations in our patients. The interval between the onset of symptoms and therapy start was 5-11 days (mean: 9 days). No patients were initially diagnosed with bacterial meningitis, two patients were initially suspected of having infection of unknown origin. In the non-uremic patient group, klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae were the most frequently detected pathogens, while pseudomonas aeruginosa and coagulase-negative Staphylococcus were the most prevalent in the uremic patients group. The overall mortality rates for the non-uremic and uremic patient groups were 33 and 78% respectively. CONCLUSION: The mortality rate for bacterial meningitis in the uremic patients group remained high. Due to non-specific manifestations and slow evolution, bacterial meningitis was commonly misdiagnosed as uremic encephalopathy. Therefore, effective treatment was usually delayed. To avoid treatment failure, early diagnosis, careful monitoring of clinical condition and appropriate antibiotic choices are necessary.

Adult↗