acyclovir and Meningitis--Bacterial

Infectious meningitis and encephalitis are associated with significant morbidity and mortality worldwide. Acute bacterial meningitis is rapidly fatal and early recognition and institution of therapy are imperative. Viral meningitis is typically a benign self-limited illness. Chronic meningitis (defined as presenting with >4 weeks of symptoms) is most often caused by tuberculosis and fungal infection. Because the diagnostic testing for tuberculous meningitis is insensitive and cultures often take weeks to grow, therapy is often initiated empirically when the diagnosis is suspected. Human simplex virus encephalitis is the most common cause of encephalitis and requires prompt treatment with intravenous acyclovir.

Topics: Acyclovir; Encephalitis; Humans; Meningitis, Bacterial; Meningitis, Viral

The purpose of this review is to give an overview of viral meningitis and then focus in on some of the areas of uncertainty in diagnostics, treatment and outcome.. Bacterial meningitis has been declining in incidence over recent years. Over a similar time period molecular diagnostics have increasingly been used. Because of both of these developments viral meningitis is becoming relatively more important. However, there are still many unanswered questions. Despite improvements in diagnostics many laboratories do not use molecular methods and even when they are used many cases still remain without a proven viral aetiology identified. There are also no established treatments for viral meningitis and the one potential treatment, aciclovir, which is effective in vitro for herpes simplex virus, has never been subjected to a clinical trial.. Viruses are in increasingly important cause of meningitis in the era of declining bacterial disease. The exact viral aetiology varies according to age and country. Molecular diagnostics can not only improve the rate of pathogen detection but also reduce unnecessary antibiotics use and length of hospitalization. Further research is required into treatments for viral meningitis and the impact in terms of longer term sequelae.

Topics: Acyclovir; Antiviral Agents; Humans; Incidence; Meningitis, Bacterial; Meningitis, Viral; Molecular Diagnostic Techniques; Simplexvirus

Powassan virus (POWV) is a rarely diagnosed cause of encephalitis in the United States. In the Northeast, it is transmitted by Ixodes scapularis, the same vector that transmits Lyme disease. The prevalence of POWV among animal hosts and vectors has been increasing. We present 8 cases of POWV encephalitis from Massachusetts and New Hampshire in 2013-2015.. We abstracted clinical and epidemiological information for patients with POWV encephalitis diagnosed at 2 hospitals in Massachusetts from 2013 to 2015. We compared their brain imaging with those in published findings from Powassan and other viral encephalitides.. The patients ranged in age from 21 to 82 years, were, for the most part, previously healthy, and presented with syndromes of fever, headache, and altered consciousness. Infections occurred from May to September and were often associated with known tick exposures. In all patients, cerebrospinal fluid analyses showed pleocytosis with elevated protein. In 7 of 8 patients, brain magnetic resonance imaging demonstrated deep foci of increased T2/fluid-attenuation inversion recovery signal intensity.. We describe 8 cases of POWV encephalitis in Massachusetts and New Hampshire in 2013-2015. Prior to this, there had been only 2 cases of POWV encephalitis identified in Massachusetts. These cases may represent emergence of this virus in a region where its vector, I. scapularis, is known to be prevalent or may represent the emerging diagnosis of an underappreciated pathogen. We recommend testing for POWV in patients who present with encephalitis in the spring to fall in New England.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Animals; Antibodies, Viral; Antiviral Agents; Brain; Encephalitis Viruses, Tick-Borne; Encephalitis, Tick-Borne; Female; Flavivirus; Humans; Ixodes; Magnetic Resonance Imaging; Male; Massachusetts; Meningitis, Bacterial; Middle Aged; New Hampshire; Prevalence; Seasons; United States; Young Adult

A 51-year-old man with no underlying disease was referred to our hospital, complaining of mild headache. In May 2004 he developed headache of sudden onset in the occipital region and neck pain. He visited our hospital the following morning. At the first visit, there was no fever and only an analgesic was prescribed. The headache alleviated, with only occasional mild episodes thereafter. However, 2 days later, the headache aggravated again, associated this time with elevated body temperature (38 degrees C). The patient visited our hospital and a lumbar puncture was performed; examination of the cerebrospinal fluid revealed marked elevation of the cell count (mononuclear cell-dominant). The patient was admitted to the hospital and started on treatment with cefotaxime and acyclovir. However, the symptoms persisted and 10 days later, the cerebrospinal fluid culture yielded a growth of Campylobacter jejuni (C. jejuni). The antibiotic was therefore changed to panipenem, which resulted in prompt resolution of the symptoms. To the best of our knowledge, meningitis caused by C. jejuni in an immunocompetent adult is extremely rare. This case highlights the importance of bearing in mind the possibility of C. jejuni meningitis in a patient of meningitis associated with mononuclear cell-dominant pleocytosis of the cerebrospinal fluid.

Topics: Acyclovir; Campylobacter Infections; Campylobacter jejuni; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Humans; Immunocompetence; Male; Meningitis, Bacterial; Middle Aged; Thienamycins; Treatment Outcome

We report what we believe to be the first two cases of acute interstitial nephritis associated with vancomycin and ceftriaxone therapy in adults. A 40-year-old man with a medical history of traumatic brain injury and tonic-clonic seizure disorder was admitted to the hospital with a seizure episode and temperature of 103 degrees F. He was administered ceftriaxone, vancomycin, and acyclovir for suspected bacterial and/or viral meningitis. On day 4, the patient was noted to have diffuse erythematous plaques on the neck, chest, arms, abdomen, and back, as well as an elevated serum creatinine level of 3.1 mg/dl (baseline 0.9 mg/dl) and an elevated eosinophil count (6%). Dermatology and renal consultations were obtained, and a diagnosis of suspected acute interstitial nephritis was made. After a 3-day course of antibiotic treatment (day 4 of hospitalization), all antibiotics were discontinued and topical triamcinolone 0.1% ointment and hydrocortisone 2.5% cream were begun for the rash. The patient was discharged 5 days later with improvement in the rash, serum creatinine level (1.0 mg/dl), and eosinophil count (0.9%). A 59-year-old woman with a medical history of diabetes mellitus was admitted to the hospital with a serum creatinine level of 3.7 mg/dl, eosinophil count of 8.4%, and fractional excretion of sodium of 2.94%. The patient had been receiving treatment with vancomycin and ceftriaxone for osteomyelitis for 28 days before this hospital admission. Her baseline serum creatinine level (before antibiotic therapy) was 1.0 mg/dl. Renal consultation was obtained, and a diagnosis of probable acute interstitial nephritis was made. Ceftriaxone and vancomycin were discontinued, and her serum creatinine level gradually decreased to 3.3 mg/dl and then further to 1.5 mg/dl over the next 3 months. Use of the Naranjo adverse drug reaction probability scale revealed that the adverse reaction was possible in the first case and probable in the second case. Health care professionals need to be cognizant that drug-induced acute interstitial nephritis can be associated with concomitant administration of ceftriaxone and vancomycin therapy. Early detection of this rare adverse reaction is paramount in order to prevent acute renal insufficiency.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Nephritis, Interstitial; Vancomycin

To determine the association of the use of the multiplex assay meningitis/encephalitis panel with clinical management of suspected meningitis.. A cross-sectional study was conducted with children 0 to 18 years of age who received a lumbar puncture within 48 hours of admission for an infectious workup. Patient demographic and presenting information, laboratory studies, and medication administration were collected. The primary measure was length of stay (LOS) with secondary measures: time on antibiotics, time to narrowing antibiotics, and acyclovir doses. LOS and antibiotic times were stratified for outcomes occurring before 36 hours. Logistic regression analysis was used to account for potential confounding factors associated with both the primary and secondary outcomes. A value of. Meningitis panel use was associated with a higher likelihood of a patient LOS <36 hours (. Use of the meningitis panel was associated with a decreased LOS, time to narrowing of antibiotics, and fewer acyclovir doses. This likely is a result of the rapid turnaround time as compared with cerebrospinal fluid cultures. Additional studies to examine the outcomes related to this change in management are warranted.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Cross-Sectional Studies; Encephalitis, Herpes Simplex; Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Meningitis, Bacterial; Meningitis, Pneumococcal; Meningitis, Viral; Real-Time Polymerase Chain Reaction; Retrospective Studies; Roseolovirus Infections; Spinal Puncture

Topics: Acyclovir; Antiviral Agents; Electroencephalography; Encephalitis, Herpes Simplex; Female; Humans; Infant; Magnetic Resonance Imaging; Meningitis, Bacterial; Neuroimaging; Practice Guidelines as Topic; Seizures, Febrile; Spinal Puncture

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Drug Administration Schedule; Herpes Simplex; Humans; Infant, Newborn; Meningitis, Bacterial

Pseudomonas aeruginosa is a rare cause of infective endocarditis. The case of community-acquired P. aeruginosa infective endocarditis reported here is the first described in the literature to present as bacterial meningitis. Furthermore, new risk factors for P. aeruginosa infective endocarditis, including mitral annular calcification and re-use of insulin syringes, are proposed. Treatment of P. aeruginosa infective endocarditis complicated by bacterial meningitis is discussed.

Topics: Acyclovir; Ampicillin; Calcification, Physiologic; Cefepime; Cephalosporins; Community-Acquired Infections; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Humans; Meningitis, Bacterial; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Vancomycin

A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions.

Topics: Abscess; Acyclovir; Aged; Aminoglycosides; Anesthesia, Epidural; Anti-Bacterial Agents; Dibekacin; Drug Therapy, Combination; Epidural Space; Female; Herpes Zoster; Humans; Iatrogenic Disease; Imipenem; Magnetic Resonance Imaging; Meningitis, Bacterial; Myelography; Neuralgia; Palliative Care; Spinal Diseases; Staphylococcal Infections