ro13-9904 and Brain-Diseases

Topics: Biliary Tract; Brain Diseases; Ceftriaxone; Humans; Infections

Neurotoxicity is a rare and intolerable adverse effect of ceftriaxone therapy. In most cases, it has been diagnosed on the basis of medical history rather than quantitative blood and cerebrospinal fluid testing. We report the case of a woman aged 78 years with ceftriaxone-associated encephalopathy. She regularly underwent hemodialysis. The patient received intravenous ceftriaxone at a dose of 1 g/day for 10 days for a urinary tract infection, and her consciousness level began to deteriorate during the therapy. Five days after ceftriaxone discontinuation, her symptoms rapidly improved. Thus, ceftriaxone-associated encephalopathy was suspected. Ceftriaxone levels in the blood and cerebrospinal fluid were high while the patient had disturbed consciousness. This case showed that ceftriaxone levels were related to ceftriaxone-associated encephalopathy. Therefore, the estimation of ceftriaxone levels may facilitate an accurate diagnosis.

Topics: Aged; Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Female; Humans; Renal Dialysis; Urinary Tract Infections

Ceftriaxone is a third-generation cephalosporin commonly used to treat infection. However, encephalopathy is an emerging adverse effect of ceftriaxone infusion. These patients present with various symptoms, including those of neurotoxicity, that typically resolve 1 week after discontinuation of ceftriaxone. We experienced two cases of ceftriaxone-induced encephalopathy that were successfully treated by rapid removal of ceftriaxone by hemoperfusion.

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Hemoperfusion; Humans; Neurotoxicity Syndromes; Renal Dialysis

The profile of ceftriaxone-induced encephalopathy is not well understood.. To identify risk factors associated with ceftriaxone-induced encephalopathy.. In this observational study, anonymised patient data were retrieved from the open-access Japanese Adverse Drug Event Report database for ceftriaxone users aged 20 years or higher.. Data of 256,788 individuals and 12,160 cases of encephalopathy were extracted, and 2,939 ceftriaxone users, of whom 193 had encephalopathy, were identified. A disproportionate prevalence of encephalopathy was observed among the ceftriaxone users (reported odds ratio = 1.42; 95% confidence interval [CI] = 1.23-1.65; p < 0.001). Multivariate logistic regression analysis of 2,057 ceftriaxone users showed encephalopathy was associated with female sex (odds ratio [OR] = 1.52; 95% CI, 1.05-2.19; p = 0.027), chronic kidney disease (OR = 2.32; 95% CI, 1.47-3.67; p < 0.001), a ceftriaxone dosage of > 2 g/day (OR = 2.66; 95% CI, 1.66-4.26; p < 0.001), and a treatment duration of > 14 days (OR = 1.94; 95% CI, 1.21-3.11; p = 0.006).. Patients with chronic kidney disease, receiving ceftriaxone at a dosage of > 2 g/day, being treated for over 14 days, and/or females may be at an increased risk of ceftriaxone-induced encephalopathy.

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Japan; Renal Insufficiency, Chronic

Ceftriaxone (CRO) is a long-acting third-generation cephalosporin antibiotic. We present a case of CRO-induced encephalopathy in an 84-year-old male patient with a solitary right kidney, admitted with bilateral pneumonia and right pyelonephritis. Intravenous CRO (2 g, every 24 hours) was started for the infection, but tonic-clonic seizures of the left face and left upper extremity appeared on the eighth day. To examine the relationship between CRO administration and the seizures, we measured CRO concentrations in the patients' plasma/serum and cerebrospinal fluid. The CRO concentration in blood at the onset of encephalopathy was estimated to have been approximately 60 μg/ml based on a simulation curve. We also calculated the pharmacokinetic parameters after CRO administration. The patient had about one-tenth of the total body clearance and one-third of the volume of distribution compared with healthy adults, and the elimination half-life was about three times longer.

Topics: Administration, Intravenous; Adult; Aged, 80 and over; Brain Diseases; Ceftriaxone; Humans; Male; Pneumonia; Solitary Kidney

Encephalopathy is a rare side effect of cephalosporin treatment. We herein present a case of encephalopathy induced by ceftriaxone, a third-generation cephalosporin, in a patient with renal failure. An 86-year-old woman on maintenance hemodialysis received ceftriaxone for Helicobacter cinaedi bacteremia. Her mental status deteriorated during antibiotic treatment, and an electroencephalogram revealed triphasic waves predominantly in the frontal area. Her consciousness improved after the discontinuation of the antibiotic due to the suspicion of ceftriaxone-induced encephalopathy. This is the first reported case of encephalopathy associated with high plasma and cerebrospinal fluid ceftriaxone concentrations, and provides significant evidence for a causal relationship between the administration of ceftriaxone and the onset of encephalopathy.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Brain Diseases; Ceftriaxone; Electroencephalography; Female; Helicobacter Infections; Humans; Renal Dialysis

Herpes zoster (zoster) also commonly known as "shingles," occurs following re-activation of the varicella zoster virus. It contributes a large cost burden to the U.S. health care system, with an estimated 1 million cases costing $1 billion annually. The current gold standard treatment is acyclovir, which limits viral replication. However, acyclovir has been reported to cause neurotoxicity in patients with acute or chronic kidney disease.. This case presents an occurrence of acyclovir-induced toxic encephalopathy in a patient with normal renal function. A 63-year-old male presented to the emergency department with ataxia, tremors, fluctuating aphasia, confusion, agitation, and fatigue. Results of imaging, lumbar puncture, and laboratory studies directed clinicians toward acyclovir toxicity, despite a normal creatinine level. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians will likely be the first point of contact in the health care system following the onset of acyclovir toxicity. With an increasing incidence of zoster disease, such atypical toxic manifestations may increase. Early recognition is important to avoid permanent neurologic compromise.

Topics: Acyclovir; Antiviral Agents; Brain Diseases; Ceftriaxone; Emergency Service, Hospital; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neurotoxicity Syndromes

Determination of ceftriaxone (CTRX) concentration in human cerebrospinal fluid (CSF) is required to clarify whether a high concentration of CTRX in CSF is associated with CTRX-induced encephalopathy (CIE). In our study, in order to perform an accurate analysis of CSF sample from CIE patient, we proposed HPLC with UV detection (HPLC-UV) using an octadecylsilica (ODS) column, a methanol and 10 mM phosphoric acid (25:75, v/v) mixture solution as a mobile phase, and a detection wavelength at 280 nm. The linear range was from 0.1 to 100 μg/mL (r = 0.999) in the present HPLC-UV. In the recovery tests using blank samples of human CSF and control serum spiked with CTRX, the recoveries of CTRX were >95.3%, and the RSD (n = 3) was <5.8%. We applied the proposed HPLC-UV system to determine CTRX in the CSF and serum samples obtained from a patient diagnosed as having CIE, and it was revealed that the CTRX concentrations in the CSF sample and the serum were 2.61 and 37.35 μg/mL, respectively. To the best of our knowledge, this is the first report describing the determination of CTRX concentration in a CSF sample obtained from a peritoneal dialysis patient diagnosed as having CIE.

Topics: Adult; Aged; Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Chromatography, High Pressure Liquid; Female; Humans

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Humans; Plasma; Renal Dialysis

Topics: Brain Diseases; Ceftriaxone; Humans; Plasma; Renal Dialysis; Serum Albumin

Ceftriaxone is a widely used third-generation cephalosporin showing advantageous pharmacokinetic properties and a broad antimicrobial spectrum. We herein report a case of ceftriaxone-induced neurotoxicity in a 56-year-old man on hemodialysis. Seven days after initiating high-dose ceftriaxone, the patient developed impaired consciousness along with facial myoclonus and sporadic phonation. The symptoms clearly disappeared shortly after withdrawal of the drug. Ceftriaxone is considered a safe antibiotic for patients with renal insufficiency, since it is excreted via both haptic and renal pathways. Physicians should note that antibiotic-associated encephalopathy may develop in patients administered ceftriaxone, especially in those complicated with renal dysfunction.

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Humans; Kidney Transplantation; Male; Middle Aged; Pancreas Transplantation; Renal Dialysis

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Cerebrospinal Fluid; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Polymerase Chain Reaction; Spinal Puncture; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Anti-Bacterial Agents; Ascites; Ascitic Fluid; Brain Diseases; Ceftriaxone; Diagnosis, Differential; Humans; Liver Cirrhosis, Alcoholic; Liver Transplantation; Male; Middle Aged; Paracentesis; Percussion; Postoperative Complications; Renal Insufficiency; Risk Factors; Serum Albumin

A 62-year-old man with adenocarcinoma underwent complete resection with a right upper lobectomy and en-bloc resection of the chest wall, with metallic clips applied to the vertebral nerve roots. A sudden deterioration in neurological status occurred due to pneumocephalus and ascending bacterial meningitis resulting from a subarachnoid-pleural fistula. The neurological status normalized after thoracoplasty and ceftriaxone treatment.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Fistula; Humans; Iatrogenic Disease; Lung Neoplasms; Male; Meningitis, Pneumococcal; Middle Aged; Pleural Diseases; Pneumocephalus; Pneumonectomy; Reoperation; Respiratory Tract Fistula; Streptococcus pneumoniae; Subarachnoid Space; Thoracoplasty; Tomography, X-Ray Computed; Treatment Outcome

Encephalopathy is a rare side effect of third- and fourth-generation cephalosporins. Renal failure and previous disease of the central nervous system predispose to this neurotoxicity. We describe a case of encephalopathy with generalised triphasic waves in a patient with pre-existent cerebrovascular disease who was treated with ceftriaxone for a urinary tract infection. Early recognition of this complication is relevant given that ceftriaxone discontinuation reverted the neurological syndrome.

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Female; Humans; Middle Aged; Neurotoxicity Syndromes; Risk Factors; Urinary Tract Infections

Patients with End-stage Renal Disease being immunocompromised; are prone to a variety of infections, sometimes, rare ones, more than the general population. This fact should alert the physicians to be more vigilant and have a broader scope when considering the etiology of infections in such patients. We report the case of a 65-year-old man who had a very stormy hospital stay secondary to cerebral nocardiosis with multiple brain abscesses, prolonged unconsciousness and neurological deficits. However, the patient was treated successfully, surgically and chemotherapeutically. He was discharged home in a good condition.

Topics: Aged; Amikacin; Brain Abscess; Brain Diseases; Brain Edema; Ceftriaxone; Humans; Kidney Failure, Chronic; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Unconsciousness; Vancomycin

Bartonella hensalae is a poorly known cause of encephalopathy in young subjects.. A 17 year-old adolescent was admitted in a state of emergency because of frequent convulsive seizures and inter-critical drowsiness. The diagnosis of encephalopathy was made on the association of these clinical signs and electro-encephalographic abnormalities. The presence of a cat in his home, a right axillary lymph node that had appeared in a context of fever, and positive serological kinetics related this encephalopathy to a bartonellosis. The course was good.. Diagnosis of a Bartonella hensalae encephalopathy is based on a range of anamnesic, clinical and microbiological arguments. The potential interest of antibiotic therapy and its modalities remains to be established.

Topics: Adolescent; Anti-Bacterial Agents; Bartonella henselae; Brain Diseases; Cat-Scratch Disease; Ceftriaxone; Doxycycline; Electroencephalography; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Time Factors; Treatment Outcome

The central nervous system (CNS) may be affected in up to 50% of patients with Whipple's disease and this can occur even with little or no gastrointestinal involvement. We describe a 63-year-old patient in whom CNS involvement with Whipple's disease had the clinical and imaging features of a brain infarction. Treatment with aspirin and ceftriaxone followed by trimethoprim-sulfamethoxazole resulted in a good neurological recovery and complete remission of the malabsorption syndrome. Cerebral Whipple's disease resembling a stroke syndrome has so far been reported in only two other patients and in both cases it represented the first presentation of the disease. Arterial or arteriolar fibrosis, thrombosis and thickening associated with the inflammation of adjacent brain parenchyma and leptomeninges, and cerebral vasculitis caused by the hematogenous spread of Tropheryma whippelii to the brain may all be important triggers of brain infarction in patients with Whipple's disease. Our case report highlights the important point that cerebral Whipple's disease with the features of a stroke syndrome, if recognized early and treated aggressively with antibiotics, could have a favorable course with no long-term disability sequelae.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Brain Diseases; Ceftriaxone; Cerebral Infarction; Drug Therapy, Combination; Humans; Male; Middle Aged; Stroke; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

The efficacy of intravenous ceftriaxone, 2 g per day for 30 days, was evaluated in a case series of 18 consecutive patients who met strict criteria for Lyme encephalopathy. Months to years after classic manifestations of Lyme disease, the 18 patients presented with memory difficulty, minor depression, somnolence, or headache. Sixteen (89%) had abnormal memory scores; 16 (89%) had cerebrospinal fluid (CSF) abnormalities, and all 7 patients tested had frontotemporal perfusion defects on single photon emission computed tomographic (SPECT) imaging. Six months after treatment, memory scores in the 15 patients who completed the study according to protocol were significantly improved (P<.01). In the 10 patients who had follow-up CSF analyses, total protein levels were significantly lower (P<.05). In the 7 patients who had SPECT imaging, posttreatment perfusion was significantly better (P<.01). Twelve to 24 months after treatment, all 18 patients rated themselves as back to normal or improved. We conclude that Lyme encephalopathy can be treated successfully with ceftriaxone.

Topics: Adult; Aged; Brain; Brain Diseases; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Female; Humans; Injections, Intravenous; Lyme Disease; Male; Memory Disorders; Middle Aged; Treatment Outcome

Whipple's disease, an infection with the recently identified intracellular bacillus Tropheryma whippelii, is a systemic disorder that can be life threatening when untreated. In a few patients, the signs and symptoms of the disease are similar to those of sarcoidosis, and this illness is referred to as sarcoidlike Whipple's disease. This variant must be recognized because patients with sarcoidlike Whipple's disease must be treated with antibiotics instead of corticosteroids, which would be indicated for patients with true sarcoidosis. We describe a 53-year-old man who had sarcoidlike Whipple's diseases with polyvisceral granulomatous dissemination that was treated with procaine penicillin G and streptomycin followed by doxycycline. His condition initially improved. However, during his 4-month course of treatment he developed a cerebral relapse; this relapse was successfully treated with ceftriaxone and cefixime.

Topics: Brain Diseases; Cefixime; Cefotaxime; Ceftriaxone; Diagnosis, Differential; Humans; Male; Middle Aged; Recurrence; Sarcoidosis; Whipple Disease

Lyme encephalopathy (LE) presents with subtle neuropsychiatric symptoms months to years after onset of infection with Borrelia burgdorferi. Brain magnetic resonance images are usually normal. We asked whether quantitative single photon emission computed tomography (SPECT) is a useful method to diagnose LE, to measure the response to antibiotic therapy, and to determine its neuroanatomic basis. In 13 patients with objective evidence of LE, SPECT demonstrated reduced cerebral perfusion (mean perfusion defect index [PDI] = 255), particularly in frontal subcortical and cortical regions. Six months after treatment with 1 month of intravenous ceftriaxone, perfusion significantly improved in all 13 patients (mean PDI = 188). In nine patients with neuropsychiatric symptoms following Lyme disease, but without objective abnormalities (e.g., possible LE), perfusion was similar to that of the treated LE group (mean PDI = 198); six possible LE patients (67%) had already received ceftriaxone prior to our evaluation. Perfusion was significantly lower in patients with LE and possible LE than in 26 normal subjects (mean PDI = 136), but 4 normal subjects (15%) had low perfusion in the LE range. We conclude that LE patients have hypoperfusion of frontal subcortical and cortical structures that is partially reversed after ceftriaxone therapy. However, SPECT cannot be used alone to diagnose LE or determine the presence of active CNS infection.

Topics: Adult; Aged; Brain Diseases; Brain Ischemia; Ceftriaxone; Cephalosporins; Cerebrovascular Circulation; Enzyme-Linked Immunosorbent Assay; Female; Humans; Lyme Disease; Magnetic Resonance Imaging; Male; Mental Disorders; Middle Aged; Reference Values; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Brain Diseases; Brain Neoplasms; Brain Stem; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Doxycycline; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Neurosyphilis; Penicillins; Radiographic Image Enhancement; Tomography, X-Ray Computed

Lyme disease, caused by the tick-borne spirochete Borrelia burgdorferi, is associated with a wide variety of neurologic manifestations. To define further the chronic neurologic abnormalities of Lyme disease, we studied 27 patients (age range, 25 to 72 years) with previous signs of Lyme disease, current evidence of immunity to B. burgdorferi, and chronic neurologic symptoms with no other identifiable cause. Eight of the patients had been followed prospectively for 8 to 12 years after the onset of infection.. Of the 27 patients, 24 (89 percent) had a mild encephalopathy that began 1 month to 14 years after the onset of the disease and was characterized by memory loss, mood changes, or sleep disturbance. Of the 24 patients, 14 had memory impairment on neuropsychological tests, and 18 had increased cerebrospinal fluid protein levels, evidence of intrathecal production of antibody to B. burgdorferi, or both. Nineteen of the 27 patients (70 percent) had polyneuropathy with radicular pain or distal paresthesias; all but two of these patients also had encephalopathy. In 16 patients electrophysiologic testing showed an axonal polyneuropathy. One patient had leukoencephalitis with asymmetric spastic diplegia, periventricular white-matter lesions, and intrathecal production of antibody to B. burgdorferi. Among the 27 patients, associated symptoms included fatigue (74 percent), headache (48 percent), arthritis (37 percent), and hearing loss (15 percent). At the time of examination, chronic neurologic abnormalities had been present from 3 months to 14 years, usually with little progression. Six months after a two-week course of intravenous ceftriaxone (2 g daily), 17 patients (63 percent) had improvement, 6 (22 percent) had improvement but then relapsed, and 4 (15 percent) had no change in their condition.. Months to years after the initial infection with B. burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis. These chronic neurologic abnormalities usually improve with antibiotic therapy.

Topics: Adult; Aged; Brain Diseases; Ceftriaxone; Chronic Disease; Encephalitis; Female; Humans; Lyme Disease; Male; Middle Aged; Peripheral Nervous System Diseases; Prospective Studies; Time Factors