Biomedical subjects
Publications and source records attributed to V Chotmongkol.
We report two cases of Burkholder meningitis. Case 1 presented with subacute lymphocytic meningitis, low sugar profile in CSF and positive culture for Burkholder. Case 2 presented with purulent meningitis that emerged during treatment of cryptococcal meningitis which, to our knowledge, has not been reported. Thus, Burkholder should be considered as one of the etiologic agents in this clinical setting.
We assessed the benefit of prednisolone regimen in adult-patients with tuberculous meningitis by a randomised, double-blind trial. 59 patients were treated with combined antituberculous drugs and randomised to receive oral prednisolone regimen or a placebo. There were 29 and 30 patients in the treatment and placebo groups respectively. The results revealed that prednisolone was not beneficial in patients with severe brain lesions, increased intracranial pressure and cranial nerve palsies. The role of prednisolone in patients with paraparesis, visual impairment and newly developed neurological complications during treatment needs further study.
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The results of an open study of the efficacy of itraconazole and flucytosine in 10 patients with cryptococcal meningitis are reported. The outcome revealed eight responding cases (cure in 4 cases and improvement in 4 cases), and two failure cases. One patient had a relapse which responded to amphotericin B and flucytosine. No toxicity was observed.
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A case of subacute progressive painful external ophthalmoplegia of the right eye in a 55-year-old woman is reported. CT scan of the brain, paranasal sinuses and orbits revealed normal findings. Tolosa-Hunt syndrome was diagnosed and high dose prednisolone was given. The patient later developed fever, confusion and stiffneck. Lumbar puncture showed grossly purulent CSF with Gram-positive coccobacilli and rod organism. CSF culture grew Nocardia spp. The patient made a complete recovery with trimethoprim-sulfamethoxazole treatment.
Ten cases of cerebral cysticercosis, treated with 2-week course of albendazole, were reported. The results were excellent. 9 patients were responded to this regimen in both the clinical outcomes and CT scan findings. These results indicated that a 2-week course of albendazole is effective for treatment of neurocysticercosis.
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12 patients with cryptococcal intracerebral mass lesions associated with cryptococcal meningitis are reported. There were 6 males and 6 females with a mean age of 41 years. Most of them presented with symptoms and signs of meningitis initially without focal neurological signs. Computed tomography revealed single or multiple, well or poorly marginated hypodense lesions without perilesional edema, except 1 case which had marked edema, with or without ring enhancement. One case had small hyperdense, diffuse, enhanced nodules. New lesions or progression of the existing lesions occurred during medical therapy in some patients. The clinical manifestations of patients with intracranial mass lesions did not significantly differ from patients without mass lesions, but the mortality was higher (50% vs 29%).
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The results of an open study of the efficacy of oral itraconazole therapy in 8 patients with cryptococcal meningitis are reported. Therapy is monitored by clinical response with culture, indian ink stain and cryptococcal antigen testing of CSF. Four (50%) of eight patients were cured, two (25%) had partial response, and two (25%) failed. One patient had a relapse but responded to retreatment. No toxicity was observed. Itraconazole is, therefore, suggested as a new treatment for cryptococcal meningitis.
A case of cryptococcal meningitis with unilateral paresis of the superior division of the oculomotor nerve was reported. The ocular signs were completely improved by antifungal therapy. This case demonstrates that divisional oculomotor paresis occurred in the subarachnoid portion of the third cranial nerve before its anatomic bifurcation.
A 25-year-old pregnant women with cryptococcal meningitis treated with itraconazole during the first few weeks and 12th-16th week of pregnancy is reported. She delivered a normal baby. Itraconazole should be another drug for treatment of fungal infection in pregnancy.
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Twenty-nine patients with chronic suppurative otitis media with intracranial complications are reviewed. The complications occurred predominantly in young patients with a mean age of 17 years. The most common complication was brain abscess (n = 20). The others were meningitis (n = 3), subdural abscess (n = 3), perisinus abscess (n = 2) and otitic intracranial hypertension (n = 1). The common pathogens were Gram-negative bacilli, especially Proteus and anaerobic organisms, respectively. The mortality rate was 7%.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.