Biomedical subjects
Satoshi Kamei
Publications and source records attributed to Satoshi Kamei.
[Recent management of bacterial meningitis of adult].
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[Therapy for herpes simplex virus encephalitis].
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Serial changes of intrathecal viral loads evaluated by chemiluminescence assay and nested PCR with aciclovir treatment in herpes simplex virus encephalitis.
OBJECTIVE: We assessed the potential for estimating the effects of antiviral therapy on the clearance of intrathecal herpes simplex virus (HSV) antigens as evaluated by the chemiluminescence assay (CL) and on that of intrathecal HSV-DNA as evaluated by the nested polymerase chain reaction (PCR) in serial patients with herpes simplex virus encephalitis (HSVE). METHODS: The materials comprised serial cerebrospinal fluid (CSF) samples from 18 patients with HSVE. All patients were diagnosed as having HSVE retrospectively based on the detection of intrathecal HSV antigens by the CL, that of HSV-DNA by the nested PCR, and also serological confirmation of intrathecal antibody production. The relationships between the days of aciclovir therapy and serial HSV viral loads as evaluated by the CL and nested PCR in the serial CSFs were assessed. RESULTS: The serial intrathecal viral loads evaluated by the CL and nested PCR declined after the commencement of aciclovir administration in all patients. The serial alterations of the intrathecal viral load evaluated by the CL in each patient were similar to those of the intrathecal viral load evaluated by the nested PCR. The initial and maximum viral loads evaluated by the CL and nested PCR showed a wide distribution in the CSF samples taken from the patients with poor and good outcomes. Differences in the means of the viral loads in the CSF samples taken from the patients between a poor outcome and a good outcome were not evident. A transient increase of viral load as evaluated by these two methods was noted in the same 4 patients. The viral loads in these 4 patients also declined in the subsequent CSF samples. The outcome of these 4 patients was good in one patient and poor in the others. CONCLUSION: Evaluation of intrathecal viral antigens by the CL has a potential for estimating the effects of antiviral therapy, as does evaluation of the intrathecal HSV-DNA by the nested PCR. The intrathecal viral loads evaluated by CL and nested PCR were not a predictor of outcome in HSVE.
[Dementia due to bacterial, fungal and protozoal neuro-infections].
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[A case of cerebellar infarction with pure dysarthria].
We report a 69-year-old man with pure ataxic speech. He was admitted to the surgical ward of our hospital because of exercise-induced pain in the right arm. He underwent angiography of the right arm, and was discharged the next day. When he returned home, he exhibited an acute-onset dysarthria. He was admitted to our neurology ward the next day because the dysarthria did not improve. On admission, neurological examinations revealed moderately ataxic speech, but other neurological findings were within normal limits. Cranial MRI revealed an infarct localized from the lobulus simplex to the lobulus quadrangularis in the right cerebellum. Three cases of pure dysarthria due to cerebellar infarction have been reported previously. We compared cerebellar lesions in the 4 cases of pure dysarthria due to cerebellar infarction. Since the lobulus simplex of the upper cerebellar hemisphere was involved in all 4 cases, we speculated that ataxic speech occurred from the impairment of this cerebellar area.
[Bacterial meningitis: determination of pathogens and therapeutic management].
Recent aspects of pathogen determination and therapeutic management are reviewed based on a clinical analysis of 50 of our adult patients with bacterial meningitis (BM). The sensitivity for detecting pathogens using gram-stained smears and cultures of CSF was high in untreated patients, but low in patients previously treated with antibiotics. Latex agglutination for antibodies of pathogens is rapid and has a potential for determining pathogens in partially treated meningitis. The PCR also has a potential for determining pathogens in pre-treated, culture-negative cases and for detecting whether the bacterial pathogen is resistant or sensitive to antibiotics. The initial empiric regimen of antibiotics has been modified with elevation in the detection rate of drug-resistant bacilli. The proportion of patients undergoing treatment with VCM and/or Carbapenems has recently increased at our department. A combination of dexamethasone under administration of antibiotics has also been established as effective in adult BM. On admission, some patients are difficult to diagnose as BM rather than herpes simplex encephalitis (HSVE). A serum CRP value of >2.0 mg/dl proved useful for such different diagnosis in our patients. The predictors of a poor outcome based on multivariate logistic analysis in our BM patients were level of unconsciousness and sepsis.
[The analysis of cytokines in cerebrospinal fluid (CSF) in two cases of non-herpetic acute limbic encephalitis (NHALE)].
We report two cases of non-herpetic acute limbic encephalitis (NHALE) which showed elevation of interleukin (IL)-6 in the cerebrospinal fluid (CSF). [Case 1] The patient was a 25-year-old woman who was admitted to another hospital because of fever and severe headache, following common cold. After the admission, she developed severe disturbance of consciousness and suffered from generalized convulsions, and was then transferred to our hospital. The CSF examination revealed neither pleocytosis nor elevation of total protein. Her consciousness improved by intravenous administration of high-dose methylprednisolone, but mild retrograde amnesia and symptomatic epilepsy remained as sequelae. [Case 2] The patient was a 58-year-old man who was admitted to our hospital because of fever, severe headache, and mild disturbance of consciousness, following common cold. After the admission, he exhibited marked psychiatric symptoms and severe amnestic syndrome. The CSF examination revealed mild lymphocytic pleocytosis and mild elevation of total protein. His clinical symptoms improved markedly by intravenous administration of high-dose methylprednisolone, but mild retrograde amnesia and personality changes remained. Cranial MRI showed reversible high signal intensity lesions in bilateral hippocampi and amygdaloid bodies on diffusion weighted images (DWI) in both cases. No laboratory findings suggesting herpes simplex virus infection or malignancy were detected in either case. In the CSF analysis of cytokines including IL-1 beta, IL-2, IL-6, IL-10, tumor necrosis factor alpha, and interferony gamma, only IL-6 was elevated in both cases. We recognized four clinical features in both cases as follows: 1. the episode of preceding infection such as common cold, 2. appearance of reversible high signal intensity lesions in bilateral hippocampi and amygdaloid bodies on DWI, 3. elevation of only IL-6 in CSF, and 4. marked neurological improvement by intravenous administration of high-dose methylprednisolone. We speculate that the immune reaction of the host might play some significant roles in the pathogenesis of NHALE, based on these four clinical features.
[Blepharospasm in a patient with thymoma and positive anti-acetylcholine receptor antibody].
We report a rare case of a 70-year-old woman diagnosed as having blepharospasm with positive anti-acetylcholine receptor antibody. Blepharospasm developed in November, 2000, and increased in frequency, and worsened toward the evening. She complained of difficulty in her eyelid opening from October, 2002. Neurological examinations revealed blepharospasm and mild ptosis in both eyes. Tensilon test was negative. Waning and waxing were not detected in bilateral orbicularis oculi muscles by Harvey-Masland test. However, anti-acetylcholine receptor antibody was positive and thymoma in the anterior mediastinum was also found by the computed tomography of the chest. After the thymectomy, frequency of blepharospasm decreased. When blepharospasm worsened toward the evening, the co-existence of myasthenia gravis should be borne in mind.
[Current clinical advancements of meningoencephalitis in Japan].
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Correlation between quantitative-EEG alterations and age in patients with interferon-alpha-treated hepatitis C.
The authors recently observed alterations in the quantitative EEG findings in patients with chronic hepatitis C who were treated with interferon-alpha (IFN-alpha). However, the factors that influenced such EEG alterations remain unclear. The authors evaluated the correlation between QEEG alterations that occurred during IFN-alpha treatment and the age of 98 patients with chronic hepatitis C. These patients underwent blind, prospective, and serial quantitative EEG examinations. IFN-alpha was administered intramuscularly at 9 x 10 IU daily for the first 4 weeks and then three times per week for the next 20 weeks. Serial EEGs were obtained before, at 2 and 4 weeks, and at 2 to 3 days after the treatment. The absolute powers of each frequency band at different stages of the treatment were determined by QEEG. The ages of the patients were classified into five groups: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and > or =60 years. The relationship between the alterations in power values and age was statistically evaluated. As the age of the patients increased, the alterations in power values for the slow waves, alpha 2, and fast waves during IFN-alpha treatment became more remarkable, and significant (repeated-measure analysis of variance; P < 0.0001). The alterations of EEG occurring during IFN-alpha treatment were marked in older patients.