Posts filed under ‘Infecciones del SNC’

Pulmonary Cryptococcosis – Localized and Disseminated Infections in 27 Patients with AIDS.

Clinical Infectious Diseases September 1995 V.21 N.3 P.628–633

Marie-Caroline Meyohas; Patricia Roux; Diane Bollens; Christos Chouaid; Willy Rozenbaum …

We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans.

Twenty-seven patients (32%) had pulmonary cryptococcosis.

C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites.

All but one of the 27 patients had detectable CA in serum.

The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%).

Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident.

Outcome was poor (mean survival time, 23 weeks) despite treatment.

Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.





November 24, 2018 at 8:03 pm

Cryptococcus neoformans Pulmonary Infection in HIV-1-Infected Patients

Journal of Acquired Immune Deficiency Syndrome May 1990 V.3  N.5 P.480-484

Clark, Rebecca A.; Greer, Donald L.; Valainis, Gregory T…..

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1).

We review the initial presentation and clinical course of 18 HIV-1-infected (HIV +) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined.

The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%).

Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis.

Of six patients with an isolated Cn pulmonary infection, five have subsequently died.

Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse.

Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.



November 24, 2018 at 8:01 pm

Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina

Arch Argent Pediatr 2018;116(1):e47-e53 / e47

Dra. Ángela Gentilea, Dra. Julia Bakira, Dra. Gabriela Ensinckb, Dr. Aldo Cancellarac, Dr. Enrique V. Casanuevad, Dra. Verónica Firpoe, Dr. Martín Carusof, Dra. María F. Lucióna, Dr. Alejandro Santillán Iturresg, Dra. Fabiana Molinah, Dr. Héctor J. Abatei, Dra. Andrea Gajo Ganej, Dr. Santiago López Papuccib y Grupo de Trabajo de Staphylococcus aureus*


Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave.


Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C.


Estudio analítico transversal. Se incluyeron todos los pacientes ≤ 15 años con infección por Staphylococcus aureus adquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014.


Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4,  respectivamente (p= 0,0057).

Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%.

La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina.

La letalidad fue 2,2% y los factores de riesgo asociados fueron [OR (IC 95%)] edad ≥ 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55).


La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los ≥ 8 años y las clínicas de neumonía, meningitis y sepsis.


October 6, 2018 at 5:42 pm

Long-term outcomes of patients with Streptococcus suis infection in Viet Nam: A case-control study

Journal of Infection February 2018 V.76 N.2 P.159–167


  • Severe hearing and vestibular impairment persists in many S. suis survivors.
  • Hearing function tends to only improve in the first 3 months post discharge.
  • Vestibular dysfunction shows little recovery during the follow-up time period.
  • Survivors reported significantly lower health status and quality of life.
  • Appropriate patient management strategies are needed to reduce disease impact.


Streptococcus suis is a zoonotic cause of severe meningitis and sepsis in humans. We aimed to assess the long-term outcomes in patients who survived S. suis infection, in particular the progress and impact of vestibulocochlear sequelae.


This case-control study evaluated outcomes of S. suis infection at discharge and 3 and 9 months post-discharge for 47 prospectively enrolled cases and at 11–34 months for 31 retrospectively enrolled cases. Outcomes in patients were compared to 270 controls matched for age, sex and residency.


The prevalence ratio (PR) of moderate-to-complete hearing loss was 5.0(95%CI 3.6–7.1) in cases at discharge, 3.7(2.5–5.4) at 3 months, 3.2(2.2–4.7) at 9 months, and 3.1(2.1–4.4) in retrospective cases compared to controls. Hearing improvement occurred mostly within the first 3 months with a change in hearing level of 11.1%(95%CI 7.0–15.1%) compared to discharge. The PR of vestibular dysfunction was 2.4(95%CI 1.7–3.3) at discharge, 2.2(1.4–3.1) at 3 months, 1.8(1.1–2.5) at 9 months, and 1.8(1.1–2.6) for retrospective cases compared to controls. Cases also indicated more problems with mobility, self-care and usual activities.


Both hearing and vestibular impairment were common and persist in cases. Appropriate patient management strategies are needed to reduce the incidence and impact of these sequelae.





September 29, 2018 at 7:43 pm

Streptococcus pyogenes and invasive central nervous system infection.

SAGE Open Med Case Rep. 2018 May 31;6:2050313X18775584.

Randhawa E1, Woytanowski J1, Sibliss K2, Sheffer I2.

1 Division of Internal Medicine, Department of Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.

2 Division of Infectious Disease & HIV Medicine, Department of Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.


Streptococcus pyogenes is a Gram-positive beta-hemolytic bacteria, also known as group A streptococci, that causes a range of infections. The most common presentation is acute pharyngitis; however, it is also implicated in skin and soft tissue infections, and less commonly bacteremia, osteomyelitis, pneumonia, otitis media and sinusitis. Group A streptococci infections of the central nervous system are exceedingly rare in the antibiotic era. The mechanism of infection is typically contiguous spread from existing infection or via direct inoculation. We present a case of an 81-year-old female with a past medical history of dementia, transient ischemic attacks, type 2 diabetes mellitus, hypertension, descending thoracic aortic aneurysm status post-stent placement in 2008, hepatitis C and hyperlipidemia who initially presented after being found unresponsive at home. Her initial symptoms were primarily of altered mentation and on evaluation was found to be in septic shock with suspicion of meningoencephalitis. Her initial workup included a computed tomography of head which was remarkable for left and right mastoid effusions. A lumbar puncture was performed with cloudy purulent fluid, an elevated white blood cell count, low glucose and elevated protein. The patient was initially started on broad spectrum coverage and soon had 4/4 blood cultures and cerebrospinal fluid cultures growing Streptococcus pyogenes. Empiric vancomycin, ceftriaxone and ampicillin were administered but switched to penicillin G in the setting of elevated total bilirubin and septic shock with multi-organ failure and narrowed to ampicillin-sulbactam based on sensitivities. Unfortunately, the patient deteriorated further due to septic shock and multi-organ failure and later died in the medical intensive care unit.


September 20, 2018 at 4:22 pm

Neisseria meningitidis Antimicrobial Resistance in Italy, 2006 to 2016

Antimicrobial Agents and Chemotherapy September 2018 V.62 N.9

Paola Vacca, Cecilia Fazio, Arianna Neri, Luigina Ambrosio, Annapina Palmieri and Paola Stefanelli

The aim of this study was to evaluate the antimicrobial susceptibilities of 866 Neisseria meningitidis invasive strains during 11 years of surveillance in Italy.

Two and six strains were resistant to ciprofloxacin and rifampin, respectively. Forty-five percent were penicillin intermediate, associated with hypervirulent serogroup C clonal complex 11.

All of the strains were susceptible to cephalosporins.



August 29, 2018 at 3:43 pm

Viral meningitis in the UK: time to speed up

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.930-931


Matthijs C BrouwerDiederik van de Beek

The differential diagnosis in patients with suspected CNS infection ranges from life-threatening disease (bacterial meningitis or herpes encephalitis) to typically less concerning disease (viral meningitis), or benign or no disease.1,  2 In the diagnostic work-up of these patients, clinical characteristics fail to differentiate between CNS infections and other diagnoses, and cerebrospinal fluid (CSF) analysis is the main contributor to the final diagnosis.3 In view of the urgent nature of this testing in patients with suspected bacterial meningitis, physicians are advised to carry out lumbar puncture without delay…



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LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.992-1003


Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

Fiona McGill, PhDMichael J Griffiths, DPhilLaura J Bonnett, PhDProf Anna Maria Geretti, PhDBenedict D Michael, PhDNicholas J Beeching, FRCPDavid McKee, FRCPPaula Scarlett, DCRIan J Hart, PhD …


Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning.


We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission.


1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year.


Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services.


Meningitis Research Foundation and UK National Institute for Health Research.



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August 25, 2018 at 11:13 am

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