RESUMEN
BACKGROUND: The value of serum and cerebrospinaL fluid (CSF) procalcitonin for differentiating between acute bacterial and viral meningitis was assessed and compared to other parameters which are usually used in clinical practice. PATIENTS: 45 adult patients (20 with bacterial and 25 with tick-borne encephalitis, TBE) were included in this prospective study. RESULTS: The median serum procalcitonin Level in patients with bacterial meningitis was 6.45 ng/ml (range 0.25-43.76 ng/ml) and in the group with viral meningitis 0.27 ng/ml (range 0.05-0.44 ng/ml). 11 patients with bacterial meningitis had an elevated procalcitonin concentration not only in serum, but also in CSF. A serum procalcitonin Level > 0.5 ng/ml had a positive predictive value for bacterial meningitis of 100% and a negative predictive value of 93%, while corresponding values for CSF procalcitonin were 100% and 74%, respectively. CONCLUSION: Serum and CSF procalcitonin concentrations > 0.5 ng/ml appear to be a reliable indicator of bacterial central nervous system (CNS) infection, with maximal positive predictive values and high negative predictive values.
Asunto(s)
Calcitonina/sangre , Calcitonina/líquido cefalorraquídeo , Meningitis Bacterianas/sangre , Meningitis Bacterianas/líquido cefalorraquídeo , Precursores de Proteínas/sangre , Precursores de Proteínas/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Péptido Relacionado con Gen de Calcitonina , Diagnóstico Diferencial , Virus de la Encefalitis Transmitidos por Garrapatas/aislamiento & purificación , Encefalitis Transmitida por Garrapatas/sangre , Encefalitis Transmitida por Garrapatas/líquido cefalorraquídeo , Encefalitis Transmitida por Garrapatas/diagnóstico , Femenino , Humanos , Masculino , Meningitis Bacterianas/diagnóstico , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Human herpesvirus 6 (HHV 6) is a known cause of central nervous system infection in immunocompromised patients. Less is known about the clinical course of HHV 6 encephalitis in immunocompetent patients. We report a case of meningoencephalitis in a 42-y-old immunocompetent patient associated with HHV 6 infection.
Asunto(s)
Encefalitis por Herpes Simple/fisiopatología , Exantema Súbito/fisiopatología , Herpesvirus Humano 6/aislamiento & purificación , Adulto , Encéfalo/patología , Encefalitis por Herpes Simple/tratamiento farmacológico , Resultado Fatal , Femenino , Herpesvirus Humano 6/patogenicidad , Humanos , Imagen por Resonancia MagnéticaRESUMEN
Six consecutive methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained in a 2-month period from tracheal aspirates of six intensive care unit (ICU) patients with nosocomial pneumonia and two MRSA isolates from nasal carriers among staff were typed to determine whether one or more strains were involved and whether nasal carriage was the source of the outbreak. Pulsed-field gel electrophoresis (PFGE) of chromosomal DNA was used to type MRSA isolates. The typing showed that the outbreak was caused by a single epidemic MRSA clone. The MRSA strain isolated from the staff was unrelated to the outbreak strain and was therefore not the source of the outbreak in this study. The source was apparently the index patient followed by transfer of MRSA to other patients on medical equipment or on the hands of staff who did not adhere strictly to infection control measures.