Biomedical subjects
Publications and source records attributed to L Kepa.
A case of measles encephalitis in a man aged 18 years was described. Attention is called to the relatively rare occurrence of such neurological complications in measles, diagnostic difficulties and good therapeutic results after corticosteroids and antiviral drugs. For reducing the incidence of measles and its neurological complications the author suggests the usefulness of protective re-vaccination against measles.
A case of adverse side effects of co-trimoxazole (Biseptol) was observed, with predominance of neurological changes in the clinical picture. Attention is called to the infrequent occurrence of such side effects of this drug and to the necessity of prompt diagnostic and therapeutic management of such cases.
From 1983 to 1990, at the I Clinic of Infectious Diseases, Silesian Academy of Medicine in Bytom, 995 patients with meningitis and encephalitis were treated; the average age was 17.86 years. After cerebrospinal fluid (CSF) examinations the patients were divided into groups. The first group consisted of patients with suppurative meningitis and encephalitis (202-20.30%), the other group were patients with aseptic meningitis (309-31.06%), a separate group consisted of patients with mumps meningitis (484-48.06% cases). In the group with suppurative meningitis and encephalitis etiological agents were isolated (Gram stain smear and/or culture of CSF) in 50.99% of cases. The most common causes of suppurative neuroinfections were: Neisseria meningitides and Streptococcus pneumoniae (in 23.76% cases). The increasing number of bacteriological tests positive results was observed during the analyzed period. The etiology of aseptic inflammation diseases of the central nervous system was defined with the help of serologic blood tests in 10-15%, and serologic confirmation of mumps meningitis was as high as 80% of cases. In the group of purulent neuroinfections, during the 8-year observation, 36 deaths occurred (17.82% of these patients). The observed tendency of the death rate decrease is concerned to be a result of better microbiological diagnostics and the possibility of an early aimed antibiotic therapy.
A case of the Guillain-Barré syndrome in a child aged 4 years during mumps was described. Attention is called to the relatively rare occurrence of such neurological complications in mumps, diagnostic difficulties and good therapeutic results after corticosteroids.
On the basis of a literature review and own observations the author discusses the aetiology, pathogenesis, clinical course and treatment of encephalitis caused by herpes virus. Attention is called to the therapeutic methods.
Seventeen cases of the suppurative meningitis complicated by hearing loss have been analysed clinically. Emphasis is on the possibility of such a complication in any case of the suppurative infection of CNS. The authors have shown the necessity of otolaryngological examinations in each patient, basing on their own experience and available literature. An early diagnosis and appropriate treatment produces complete recover or decreases the degree of hearing loss being a complication of the suppurative neuroinfections.
The course of purulent meningoencephalitis is described in 16 patients aged over 60 years. The observation showed that in these patients the pattern of the clinical manifestations was atypical and the course of the disease was very severe, leading to death in 56% of cases. The authors stress that in this age group the results of the treatment depend on possibly early diagnosis and beginning of adequate therapy.
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In 51 patients with meningoencephalitis the acid-base equilibrium of the cerebrospinal fluid (CSF) was assessed. In the fluid the following gasometry parameters were determined: pH, pCO2, pO2 and HCO3-, and also the levels of lactic acid, ATP, pyruvic acid, and sodium and potassium ion concentrations. The control group included 13 patients in whom on the basis of CSF examination, inflammatory disease of the central nervous system was ruled out. The results were analysed in groups of patients with purulent and lymphocytic meningitis. The changes were taken into account of the determined parameters in the course of the disease as well as their relationship with clinical condition of the patients. The differences were found in the values of acid-base equilibrium parameters of the CSF between purulent and lymphocytic meningitis. The differences of the values of the determined parameters between the patients in the group of purulent meningoencephalitis depended on their clinical condition and the outcome of the pathological process. In patients with purulent meningoencephalitis metabolic, lactic acidosis of the CSF occurred which was statistically significantly higher than in the group of patients with lymphocytic meningitis. The lowest values of pH and HCO3- concentration and the highest concentrations of lactic and pyruvic acids and potassium ion levels were found in the group of patients with purulent meningoencephalitis. The highest degree of acid-base equilibrium disturbances in the CSF was observed in the subgroup of patients with purulent meningoencephalitis who died.(ABSTRACT TRUNCATED AT 250 WORDS)
Forty-two cases of the viral encephalitis have been analysed clinically and epidemiologically. On the basis of a literature review and own observations the author discusses the aetiology, diagnosis, clinical course and treatment of encephalitis caused by viruses. An emphasis in the diagnostic methods (serodiagnosis and viral isolations) was presented. Attention is called to the early treatment with antiviral drugs.
An analysis of CT-scans of the brain in 55 patients with suspected neuroinfections is presented. All patients were treated at the I Department of Infectious Diseases of the Silesian Academy of Medicine in 1983-1992. Patients were divided into 3 groups. The first group included patients with suppurative meningitis and encephalitis, the second--with aseptic meningitis, and the third group--patients with other CNS diseases. An analysis has shown that CT-scans of the brain are very useful in an early detection of neuroinfections complications and sequelae, especially brain abscess. The author suggests that CT-scans of the brain may also play an important role in differential diagnosis of neuroinfections and other CNS diseases together with clinical symptoms.
On the basis of a literature review the author discusses the aetiology, pathogenesis, diagnosis, clinical course and treatment of central nervous system tuberculosis. Attention is called to the necessity of further improvement of diagnostic methods for making possible early diagnosis and modern treatment of this disease.
On the basis of literature the mechanisms of acid-base balance in cerebrospinal fluid (CSF) in physiological and pathological conditions were discussed. The author focused on acid-base balance in CSF in the course of meningitis and meningoencephalitis and the influence of its disorders in the pathogenesis of those illnesses of central nervous system.
In the central nervous system (CNS) infections a substantial role play inflammatory cytokines, especially TNF-alpha. They are implicated to initiate the local response leading to cerebral damage during meningitis. The purpose of this study was estimation of the diagnostic value of determining TNF-alpha concentrations in the CSF in the course of neuroinfections. Analyses were performed in 15 patients with purulent, bacterial meningitis (group A) and in 15 patients with lymphocytic meningitis (group B). CSF's concentrations of TNF-alpha were measured by the ELISA method (Genzyme Diagnostic, Cambridge, USA), on the day of admission and on the fourteenth day of treatment. In group A mean TNF-alpha concentration in CSF on admission was 285.73 pg/ml and in group B 4.07 pg/ml. On the fourteenth day of treatment mean TNF-alpha concentrations were 1.14 pg/ml and 0 pg/ml, respectively. The highest CSF TNF-alpha levels were observed in the most severely ill patients (group A). In several cases in this group there were positive correlations between TNF-alpha concentration and CSF white blood cell counts and protein concentration. Correlation of high levels of TNF-alpha with the severity of clinical course was observed in group B as well. Examination of CSF for TNF-alpha concentration could be useful in the differential diagnosis of CNS inflammations. TNF-alpha concentrations in CSF correlate with the severity of clinical course of meningitis and could have a prognostic value.