RESUMEN
OBJECT: To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. MATERIALS AND METHODS: The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. RESULTS: LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. CONCLUSION: Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.
Asunto(s)
Listeria monocytogenes , Listeriosis/tratamiento farmacológico , Meningitis por Listeria/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Niño , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
Lactic acidosis is an integral index of metabolic disturbances and severity of inflammation processes. This study was designed to measure lactate levels in blood and cerebrospinal fluid (CSF), CSF/blood lactate ratio, correlation coefficient between CSF lactate and other CSF parameters in patients with purulent meningitis of different etiology. The study included 112 patients (62 men and 50 women aged 18-70 years) admitted to No2 City Hospital, Moscow, for the treatment of meningococcal and pneumococcal meningitis (40 and 23 respectively), purulent meningitis of unknown etiology (22), staphylococcal sepsis with secondary purulent meningitis (11), serous viral meningitis (9), and non-inflammatory lesions of central nervous system (control group of 7patients). Blood and CSF lactate levels were measured on admittance, days 3- 7and 8-18 after the initiation of therapy. CSF lactate was especially high in patients with primary purulent meningitis having lower blood lactate levels. Patients with sepsis and secondary purulent meningitis had higher lactate levels in plasma than in CSF on admittance and days 8-18 after the onset of therapy; this situation reflects a generalized infectious process. CSF lactate positively correlated with protein content and pleocytosis intensity in the liquor and negatively with the glucose level. Prognosis of the disease depended on the efficiency of antibacterial therapy.
Asunto(s)
Acidosis Láctica/etiología , Ácido Láctico/líquido cefalorraquídeo , Meningitis Meningocócica/complicaciones , Meningitis Neumocócica/complicaciones , Acidosis Láctica/líquido cefalorraquídeo , Acidosis Láctica/tratamiento farmacológico , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Meningitis Meningocócica/líquido cefalorraquídeo , Meningitis Meningocócica/tratamiento farmacológico , Meningitis Neumocócica/líquido cefalorraquídeo , Meningitis Neumocócica/tratamiento farmacológico , Persona de Mediana Edad , Neisseria meningitidis Serogrupo A/aislamiento & purificación , Penicilinas/uso terapéutico , Streptococcus pneumoniae/aislamiento & purificación , Adulto JovenRESUMEN
AIM: To study diagnostic and prognostic significance of lactate in cerebrospinal fluid (CSF) and blood in patients with bacterial purulent meningitis (BPM) of different etiology. MATERIAL AND METHODS: BPM and blood lactate levels were studied in 112 patients aged 18-70 years by the enzyme assay on the biochemical analyzer Hitachi 902 at admission to hospital, on the treatment days 3-7, 8-18. RESULTS: BPM is associated with marked lactate-acidosis in CSF and moderate one in the blood. The lactate level in the blood was higher in patients with generalized infection in moderate enhancement of lactate-acidosis in CSF. Changes in CSF lactate concentration depends on the etiological factor, efficacy of antibacterial therapy, course and outcome of the disease. Direct correlation was found of CSF lactate level with that of protein level and cytosis in CSF, a negative correlation--with glucose concentration. CONCLUSION: The test for lactate concentration in the blood and CSF and their correlation (CSF/blood coefficient) is effective in differential diagnosis between BPM, serous viral meningitis, non-inflammatory lesions of CNS, for assessment of treatment efficacy, prognosis of the disease outcome.
Asunto(s)
Acidosis Láctica/epidemiología , Absceso Encefálico/epidemiología , Absceso Encefálico/microbiología , Encéfalo/microbiología , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/microbiología , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Acidosis Láctica/sangre , Acidosis Láctica/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
39 patients with acute infectious endocarditis were observed; of these, 28 patients had HIV infection at different stages of the disease. The specific features of the course of acute infectious endocarditis in HIV-infected patients were established. The severe course of acute septic endocarditis was observed in those patients whose parameters of the cell-mediated immune system (cells CD4+) were in the state of compensation or subcompensation. At different stages of HIV infection different clinical syndromes of infectious endocarditis prevailed. In patients with HIV infection the combined lesions of the heart valve apparatus were observed and mixed microflora was isolated from the blood more frequently. The development of acute septic endocarditis negatively affected the course of HIV infection and was manifested by a rapid decrease in the amount of CD4 lymphocytes.
Asunto(s)
Endocarditis Bacteriana/complicaciones , Infecciones por VIH/complicaciones , VIH-1 , Enfermedad Aguda , Adolescente , Adulto , Bacteriemia , Recuento de Linfocito CD4 , Endocarditis Bacteriana/patología , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/patología , VIH-1/inmunología , Humanos , Masculino , Sepsis/microbiología , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
Lipid peroxidation (LPO) has been studied in patients with influenza complicated by pneumonia as shown by GPL and MDA serum levels of GPL and MDA. Acute period of the disease was characterized by a sharp rise in LPO products production, especially in seriously ill patients. Administration of alpha-tocopherol promoted a significant decrease of MDA and GPL levels and more apparent clinical response. Dibunol caused minimal changes in the disease clinical pictures and LPO activity.