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PubMed2002

[A case of meningoencephalitis and spondylodiscitis caused by Campylobacter fetus subsp. fetus infection].

Campylobacter fetus subsp. fetus (C. fetus) is a gram-negative, curved, rod-shaped microaerophile, occasionally may cause meningitis or meningoencephalitis in humans. This report documents the case of 49-year-old man with lumbar spondylodiscitis and meningoencephalitis caused by C. fetus infection. On admission, the patient was delirious and severe inflammatory reactions were seen in his serum. Cerebrospinal fluid (CFS) revealed normal glucose concentration and moderate mononuclear leukocytosis. Campylobacter species, which was very difficult to be identified, was cultured from the blood and CSF. During his clinical course, the patient complained of severe back pain, and lumbar MRI showed low intensity in a T1-weighed image of the L4 and L5 vertebral bodies and high intensity in a T2-weighed image of the L4-5 disc. The patient was diagnosed with spondylodiscitis caused by C. fetus infection. Meningoencephalitis may have occurred as a secondary infection. Antibiotics were administered, and the patient's condition improved. To our knowledge, only a few cases of spondylodiscitis caused by C. fetus have been reported. A CSF glucose concentration in the normal range and mononuclear leukocytosis are atypical findings in patients with pyogenic meningitis. Therefore, neurologists must be fully aware of the possible symptoms and signs of C. fetus infection.

Campylobacter Infections↗
PubMedDate not supplied

[IgG subclasses intrathecal synthesis patterns in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis].

INTRODUCTION: There is a growing interest to know the characteristics of meningoencephalitis due to Angiostrongylus cantonensis because of it is an emergent disease. OBJECTIVE: To describe the intrathecal synthesis pattern of IgG subclasses in pediatric patients suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis. PATIENTS AND METHODS: Ten pediatric patients with the disease were studied. During the firs diagnostic lumbar puncture an eosinophilic pleocitosis was found. Simultaneously a serum sample was taken. Eight days later, a second lumbar and venous puncture was performed. To every serum and cerebrospinal fluid sample IgA, IgM, IgG, albumin and the four subclasses of IgG were quantified by immunodiffusion and a differential cell count. RESULTS: During the first diagnostic lumbar puncture, all the cases had blood cerebrospinal fluid barrier dysfunction with absence of immunoglobulins intrathecal synthesis with a mean of 450 106cells/L and 48% of eosinophils average. In the second lumbar punction there was a 40% patients with dysfunction of the blood cerebrospinal fluid barrier and with a synthesis pattern IgA+IgM+IgG in the 50% o patients and with IgA+IgG in four patients. The synthesis pattern of IgG subclasses was IgG1+IgG2 in six patients, IgG1+IgG2+IgG3 in one patient, IgG1+IgG2+IgG4 in one more patient and two patients without intrathecal synthesis. CONCLUSION: The intrathecal synthesis pattern of IgG subclasses can contribute to eosinophilic meningoencephalitis diagnosis due to Angiostrongylus cantonensis.

Angiostrongylus cantonensis↗
PubMed1992

[Acute hepatitis A (HA) presenting findings of meningoencephalitis].

A 39-year-old man, who had high grade fever and headache for 4 days was admitted to our hospital because of generalized seizure and disturbance of consciousness. He was pyrexial, but not icteric. Neurological examination revealed disorientation, nuchal rigidity and bilateral Babinski reflexes. Laboratory test results included the following: GOT 1,740 U/l, GPT 2,800 U/l, bilirubin 1.2 mg/dl, serum IgM-HA antibody cut-off index 6.8. CSF was clear, with 10 leukocytes/mm3 and protein level of 108 mg/dl. Head CT and MRI revealed no abnormality. An EEG demonstrated diffuse slowing. During the following 2 days, he had increased obtundation and labored breathing. In the second week of hospitalization his neurological conditions and liver function test results improved. A diagnosis of HA was confirmed by a finding of serum IgM-HA antibody. The neurological findings, CSF findings and clinical course indicated acute meningoencephalitis in association with HA. To our knowledge, there have been only 4 previous case reports of meningoencephalitis associated with serologically confirmed HA infection. HA virus infection might pass unnoticed, as many cases of HA infection remain anicteric or subclinical. Therefore, HA virus should also be considered as one of the etiological agents in meningoencephalitis.

Acute Disease↗
PubMed2003

[An autopsy case of cryptococcal meningoencephalitis: correlation of MRI and pathologic findings].

A comparative study of MRI and pathology was performed on a case of cryptococcal meningoencephalitis. An 11-year-old female presented with confusion and vomiting. On admission, CSF examination revealed spherical fungal cells with mild pleocytosis, decreased glucose and elevated protein level. MRI showed multiple punctate lesions in the basal ganglia with high intensity on T2-weighted image, while enhanced MRI revealed diffuse meningeal involvement. Post-mortem examination disclosed that the T2-weighted lesions found in the basal ganglia were aggregated small cystic lesions consisting of a cryptococcal invasion of Virchow-Robin spaces, termed "soap bubble lesions", characteristic findings of cryptococcal meningoencephalitis. Thus MRI findings of the basal ganglia and meninges may help to diagnose cryptococcal meningoencephalitis.

Brain↗
PubMed2005

[Primary amebic meningoencephalitis: 1st case observed in Madagascar].

The primary amebic meningoencephalitis is an acute suppurative infection that involves both the brain and the meninges. It is caused by Naegleria fowleri and is a very rare and fulminating condition, so far nearly always fatal. We report the first case in the area of Southern part of Indian Ocean that occured in a 7-year old French boy living in Madagascar. It is assumed that the disease was contracted by swimming in warm fresh water in a lake of the Madagascar east coast. Clinical signs began 10-12 days after exposure, associating headache, vomiting and pyrexia (39-40 degrees C). Upon admission in a Madagascar hospital, the patient was started on antibiotics, that did not control the disease and soon presented with a loss of consciousness and a delirium. He was transferred to Reunion island (Centre Hospitalier Départemental Félix-Guyon), where the diagnosis of primary amebic meningoencephalitis was confirmed. Therefore, he was started on high-dose of intraspinal amphotericin B, IV amphotericin B lipid complex and tetracycline. He developed myocarditis, diabetes insipidus, deep coma and subsequently died a week later. The diagnosis of amebic meningoencephalitis was based on: -- the cerebrospinal fluid examination that confirmed the diagnosis of purulent meningitis: 420 leucocytes (76% polynuclears, 14% lymphocytes), 90 red blood cells, and showed 50 ameboid trophozoites per 100 leucocytes, approximately 20 microm in size. -- the flagellate transformation test in distilled water showed two anterior flagellas that confirmed the genus Naegleria.

Amebiasis↗
PubMed2005

Bacillus cereus meningoencephalitis in preterm infants: neuroimaging characteristics.

BACKGROUND AND PURPOSE: Meningoencephalitis can severely damage the developing brain. Preterms are more prone for nosocomial infections with pathogens other than Group B streptococci and Escherichia coli. In this report we focus on the deleterious clinical course and imaging characteristics of proven Bacillus cereus meningoencephalitis. METHODS: We collected 3 cases of proven Bacillus cereus meningoencephalitis. In the medical records we focused on prenatal, perinatal, and postnatal risk factors. Imaging data of several brain ultrasounds, MR images, and diffusion-weighted images were reevaluated. RESULTS: The ultrasound and MR images show a typical pattern of mainly hemorrhagic and early cavitating, selective white matter destruction. CONCLUSION: Knowledge of this paradigm of acquired brain injury may help to better understand the natural course of these severe neonatal infections.

Bacillus cereus↗
PubMed2005

[A patient with coccidioidal meningoencephalitis].

A 37-year-old man presented with coccidioidal meningoencephalitis (CM) 1 month after a preceding case of pneumonia. Initially, he could not be definitely diagnosed with CM because of nonspecific features of the clinical, laboratory, and radiological findings. However, we began to suspect CM because the patient had lived in endemic area of coccidioidomycosis, and our subsequent analysis provided evidence of complement-fixing antibodies for Coccidioides immitis in serum and CSF, leading us to a final diagnosis. The CM was intractable, despite intensive administration of fluconazole and amphotericin B. Although the patient's CM gradually and mildly improved, he also suffered from bacterial meningoencephalitis and left putaminal hemorrhage with intraventricular hematoma, which caused persistent right hemiparesis and dementia. The incidence of coccidioidomycosis in Japan is rapidly increasing. The initial clinical manifestation of coccidioidomycosis is usually pneumonia, which in most cases heals spontaneously. Coccidioidomycosis rarely presents with meningoencephalitis, which is thought to be fatal. Immediate and adequate initiation of anti-fugal treatment is necessary to obtain a better prognosis for CM. Careful history-taking after a foreign trip is helpful when there is a suspicion of coccidioidomycosis.

Adult↗
PubMed2005

[A case of primary HIV infection presenting as meningoencephalitis].

A 23-year-old man presented with disturbance of consciousness and convulsion. Two weeks prior to his admission, he had general arthralgia, retro-orbital pain, and body temperature increase to 40 degrees C. These symptoms persisted for two weeks. He was admitted to the hospital because of general convulsion, followed by disturbance of consciousness. On admission, he was deeply lethargic. Cerebrospinal fluid obtained on admission showed pleocytosis (247/mm3) and an increased level of protein. Electroencephalogram obtained on admission disclosed diffuse slow waves. Enhanced cranial MR image did not show any abnormal lesions in the cerebral parenchyma. The patient was diagnosed as having meningoencephalitis and the treatment consisting of aciclovir, CTRX, and methylprednisolone was undertaken. A test for human immunodeficiency virus (HIV) antibody was found to be positive on the second day of hospitalization. A Western blot was positive with bands at gp160 and P24 confirming HIV infection. Antibody titers of paired acute and convalescent sera including HSV, EBV, CMV, mumps, measles, and Japanese encephalitis did not show any significant increase. The patient became alert on the 3rd day of hospitalization. Electroencephalogram obtained on the 10th day of hospitalization was normal. Western blot, which was obtained 4 months later, was positive with bands at gp120, p68, p55, p52, gp41, p40, p34, p18, including gp160 and P24. He was diagnosed as having primary HIV infection. Meningoencephalitis was attributed to acute primary HIV infection. Acute HIV infection should be considered as an etiology of meningoencephalitis.

Acyclovir↗
PubMed2005

[Procalcitonin (PCT) concentration in cerebrospinal fluid and plasma of patients with purulent and lymphocytic meningoencephalitis--own observations].

The aim of the study was assessment of usefulness of cerebrospinal fluid (CSF) and plasma procalcitonin concentration estimation in differential diagnosis of neuroinfections in adults. Examinations were carried out in 17 subjects with purulent, bacterial meningoencephalitis and in 16 patients with lymphocytic meningitis. In all individuals CSF and plasma PCT concentrations were assessed on the 1st day of hospitalization. In patients with purulent, bacterial meningoencephalitis mean CSF concentration was 0,63 ng/mL, mean plasma PCT concentration--9,97 ng/mL. Mean CSF PCT concentration in patients with lymphocytic meningitis was 0,23 ng/mL and mean plasma PCT concentration--0,27 ng/mL. Differences of mean PCT concentrations between both groups of patients were statistically significant: CSF--p<0,05 and plasma--p<0,01. Obtained results indicate usefulness of plasma PCT concentration estimation in differential diagnosis of neuroinfections in adults. Cerebrospinal fluid PCT concentration seems to be of lesser importance in differential diagnosis of neuroinfections, but value of this parameter often correlates with the severity of the clinical state of the patients and may be taken into consideration in prognosis of the course and outcome of the bacterial meningoencephalitis.

Adult↗
PubMed2006

[Cerebral salt wasting syndrome in a patient with viral meningoencephalitis].

A 53-year-old male was admitted to our hospital for a high fever. He suffered a change in personality, memory loss and disorientation as well. The findings of cerebrospinal fluid showed monocytosis, but the titers of glucose, C1 and ADA were all normal. Although there was no bacterium in the CSF, the patient's electroencephalography finding was abnormal. We diagnosed his condition as viral meningoencephalitis and started treatment with antiviral agents. Blood chemistry showed serum sodium of 130 mEq/l and plasma osmolarity was reduced to 272 mOsm/kg, while urine osmolarity was high at 353 mOsm/kg. Two potential causes of hyponatremia in this patient were the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (CSWS). Physical findings revealed a contracted extracellular fluid volume, strongly suggesting the presence of CSWS. The massive urine sodium loss overcoming sodium intake supported this diagnosis. After treatment with vigorous sodium and volume replacement for over 4 weeks, hyponatremia as well as meningoencephalitis were improved without any complication. To the best of our knowledge, this is the first report on CSWS in a patient with viral meningoencephalitis.

Diagnosis, Differential↗
PubMed2006

[EEG examination in patients with purulent, bacterial meningoencephalitis--literature review and own observations].

The study presents the literature review on EEG examination in purulent, bacterial meningoencephalitis as well as own observations carried out in 42 patients with this neuroinfection treated in I Department of Infectious Diseases of Medical University of Silesia in Bytom between 1989-2001. In 19 patients the result of the first examination was abnormal and the degree of EEG patterns pathology correlated with the severity of their clinical condition. Abnormal electroencephalogram was also noted in 7 cases in the control examination. Two of this group of patients died and in two cases pathological EEG patterns preceded epileptic seizures during further hospitalization. Besides, the conversion of normal at the beginning into abnormal EEG patterns was found in cases of purulent, bacterial meningoencephalitis various complications, e.g. brain abscess. The obtained results indicate that EEG examination carried out in the acute phase of purulent, bacterial meningoencephalitis may be helpful in the estimation of severity of patient's clinical state. Performing of EEG examination in series during and after hospitalization may be useful for monitoring the course of the disease and prognosis of its outcome.

Adolescent↗
PubMed1991

[A case of measles meningoencephalitis with marked increase of plasma cells in cerebrospinal fluid].

Marked increase of plasma cells in cerebrospinal fluid (CSF) was observed in a 22-year-old female patient with measles meningoencephalitis. Typical measles exanthema was followed, 3 days later, by neurological abnormalities such as confusion, severe meningeal signs and bilateral pyramidal signs. Immunological examination showed slight elevation of IgG, normal T cell subsets and NK cell activity in peripheral blood. The antibody titer of measles was 32x in serum (4x after 2 months). CSF contained 167 cells/mm3, 66% of which was plasma cells. Total protein was 75 mg/dl, and IgG (24.5 mg/dl) showed high values. The antibody titer of measles was 4x (1x after 2 months). The antibody index was 7.15 (N = 2). The anti-myelin antibody was 8x. Oligoclonal band in CSF was negative. The appearance of large number of plasma cells in CSF in viral meningoencephalitis is extremely rare in the literature. However, B cell activation in peripheral blood in measles encephalitis has been reported. Therefore, immunologically abnormal findings in CSF of this case suggest marked B cell activation occurring in the central nervous system in measles meningoencephalitis.

Adult↗
PubMed1990

[Meningoencephalitis in Kawasaki disease].

Kawasaki disease (KD) is a syndrome characterized by various degrees of vasculitis in small-and medium-sized arteries. We discussed the characteristic manifestations and prognosis of 5 KD patients (male 3, female 2) with meningoencephalitis in the acute stage. The incidence was 3.7% (5 of 138 patients) in our institute. The age of onset was between 3 months and 15 months. The clinical manifestations included disturbance of consciousness and seizures; disturbance of consciousness developed in all patients in the early acute stage. The duration was between 2 and 11 days; seizures developed as status convulsions in two. Electroencephalograms (EEG) demonstrated certain abnormalities in 2 of 4 patients studied. Computed-tomographic scanning (CT scan) revealed fluid collection in the frontal extracerebral space, and monocyte-predominant pleocytosis was observed in the cerebrospinal fluid (CSF) in all 5 patients studied. The age of onset in the 5 KD patients was significantly earlier than that in non-complicated cases (n = 138, P less than 0.01). Blood hemoglobin (P less than 0.05) and hematocrit (P less than 0.05), serum total protein (P less than 0.01), and serum albumin levels (P less than 0.01) were also significantly lower. Moreover the period until CRP values turned negative was significantly longer (P less than 0.05) and erythrocyte sedimentation rate was significantly lower (P less than 0.01) in these 5 patients. It was considered that meningoencephalitis in KD may develop in cases having more severe and prolonged inflammatory changes; the clinical findings revealed a serious form of KD. We suggest that this might because by vasculitis of small arteries, arterioles, capillaries, and venules, which consists of infiltration of lymphocytes and large mononuclear cells, and edema. There was no neurological sequela in 4 of the 5 patients. However, one patient was found to have hearing difficulty 3 years after the onset. Therefore, the prognosis of meningoencephalitis in KD was considered to be generally favorable.

Brain↗
PubMed1987

[Pathological anatomy and problems of the pathogenesis of pneumococcal meningoencephalitis in children].

The analysis of morphological, clinical and bacteriological data on 31 deceased children with pneumococcal meningoencephalitis is presented. The lesions observed at early and late stages of the disease are characterized in detail and the tendency of pneumococcal meningoencephalitis to a chronic course in the presence of the viable pathogen is shown. The majority of pneumococcal meningoencephalitides were proved to develop primarily, and in their pathogenesis significant role is played by the lesions of hematoencephalic barrier caused by respiratory viruses. High lethality and frequency of severe residual changes in the children with pneumococcal meningoencephalitis are due to early lesions of choroid plexuses and brain matter. In the experiment on 18 rabbits with their suboccipital challenge with 3 different pneumococcal strains, the influence of the biological properties of the pathogen on the clinical and morphological features of the illness is shown.

Acute Disease↗
PubMed1985

Amebic meningoencephalitis caused by Acanthamoeba castellani in a dog.

A natural infection of Acanthamoeba castellani, a free-living ameba, was determined to be the cause of acute, hemorrhagic, necrotizing amebic meningoencephalitis in a dog. This case is unique because previous reports of infection by the Acanthamoeba spp in dogs have not indicated its presence in the brain. Naturally developing meningoencephalitis by Acanthamoeba spp in the dog may have a pathogenesis similar to that of human beings. The ameba in this case also was observed in the lungs and kidneys, which are believed to be the primary sites of lesions in human beings that develop amebic meningoencephalitis from Acanthamoeba spp.

Amebiasis↗
PubMed1986

Differential diagnosis of granulomatous meningoencephalomyelitis, distemper, and suppurative meningoencephalitis in the dog.

Clinical differences were determined between granulomatous meningoencephalomyelitis, distemper, and suppurative meningoencephalitis in the dog. Dogs with granulomatous meningoencephalomyelitis had "head" signs on examination, which progressed to profound caudal fossa abnormalities, changes in mental status, and tetraparesis. Dogs with distemper had a gradual onset of posterior paresis; tetraparesis and occasional vestibular signs developed later in the course of disease. Dogs with suppurative meningoencephalitis had lethargy and anorexia at the time of examination, which progressed to nuchal rigidity, mental depression, tetraparesis, and profound alterations in consciousness. Analysis of cerebral spinal fluid was useful in distinguishing suppurative meningoencephalitis from the other 2 diseases. Twenty-seven cases of inflammatory disease of the CNS in dogs were reviewed. Comparisons of history, results of physical and neurologic examinations, ancillary data, and response to treatment were made. It appeared that certain clinical and neurologic features contributed to the diagnosis of these diseases.

Animals↗
PubMed1984

Clinicopathologic study of six cases of meningitis and meningoencephalitis in chimpanzees (Pan troglodytes).

Three fatal cases of purulent meningitis and one fatal case of thromboembolic necrotizing meningoencephalitis occurred in chimpanzees from the Primate Center TNO, The Netherlands. In addition, two apes had clinical signs of meningitis and were successfully treated. The severity of the residual hemiparesis and dysphagia in one of these two apes was such that it was killed for humane reasons. The histopathological diagnosis was chronic active meningoencephalitis. Streptococcus pneumoniae was isolated from five apes and Klebsiella pneumoniae from one. In the majority of cases, the primary site of infection was the upper respiratory tract. After reducing the population density, initiating a vaccination program using a commercially available human polyvalent pneumococcal vaccine, and changing the cleaning procedure of the animal facilities, no other cases of meningitis or meningoencephalitis have occurred in the chimpanzee colony in the ensuing 3.5 years.

Animals↗