ro13-9904 and Cerebrovascular-Disorders

A 20-year-old man suffered two thalamic infarctions during the course of neuroborreliosis and was successfully treated with intravenous ceftriaxone. Review of 11 additional cases of stroke and cerebral vasculitis in neuroborreliosis suggests that there is a meningovascular form of the infection with predilection for the posterior circulation and an association with the European strains of Borrelia burgdorferi.

Topics: Adult; Borrelia Infections; Ceftriaxone; Cerebrovascular Disorders; Humans; Magnetic Resonance Imaging; Male; Nervous System Diseases; Tomography, X-Ray Computed

Concentrations of ceftriaxone (CTRX) in the serum and the cerebrospinal fluid (CSF) were serially investigated after an intravenous drip infusion of 2 g per day to 14 patients with acute cerebrovascular diseases, as they were determined at 30 minutes, 3, 6, 24 hours, 3 and 7 days after first administration. The results obtained are summarized as follows: 1. Serum levels; Peak levels of CTRX in the serum were 162.0 +/- 51.2 (SD) micrograms/ml at 30 minutes after administration. Even at 24 hours after intravenous drip infusion, concentrations of CTRX were 14.9 +/- 6.15 (SD) micrograms/ml. 2. CSF levels; The CTRX concentrations in the CSF rose to 1.70 +/- 1.84 (SD) micrograms/ml at 30 minutes, 3.51 +/- 3.31 (SD) micrograms/ml at 3 hours and then decreased to 0.74 +/- 0.67 (SD) micrograms/ml at 24 hours after first infusion. 3. CTRX concentrations in serum in CSF after serially repeated infusion for 3 to 7 days were quite similar to the those obtained after the first administration. The above results indicates that CTRX is useful for the prevention of postoperative infections in the field of neurosurgery.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Cephalosporins; Cerebrovascular Disorders; Drainage; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Postoperative Complications

Ceftriaxone has been reported to reduce neuronal damage in amyotrophic lateral sclerosis and in an in-vitro model of neuronal ischaemia through increased expression and activity of the glutamate transporter, GLT1. We tested the effects of ceftriaxone on mortality, neurological outcome, and infarct size in experimental stroke in rats and looked for underlying mechanisms.. Male normotensive Wistar rats received ceftriaxone (200 mg/kg intraperitoneal) as a single injection 90 min after middle cerebral artery occlusion (90 min with reperfusion). Forty-eight hours after middle cerebral artery occlusion, infarct size (MRI) and neurological deficits were estimated. GLT1 expression was determined by real time RT-PCR, immunoblotting and promoter reporter assay, astrocyte GLT1 activity by measuring glutamate uptake. Bacterial load in various organs was measured by real time RT-PCR, neurotrophins and IL-6 by immunoblotting.. Ceftriaxone dramatically reduced early (24-h) mortality from 34.5% (vehicle treatment, n = 29) to 0% (P < 0.01, n = 19). In a subgroup, followed up for 4 weeks, mortality persisted at 0%. Ceftriaxone strongly tended to reduce infarct size, it significantly improved neuronal survival within the penumbra, reduced neurological deficits (P < 0.001) and led to an upregulation of neurotrophins (P < 0.01) in the peri-infarct zone. Ceftriaxone did not increase GLT1 expression, but increased GLT1 activity (P < 0.05).. Ceftriaxone causes a significant reduction in acute stroke mortality in a poststroke treatment regimen in animal studies. Improved neurological performance and survival may be due to neuroprotection by activation of GLT1 and a stimulation of neurotrophins resulting in an increased number of surviving neurons in the penumbra.

Topics: Animals; Anti-Bacterial Agents; Body Temperature; Brain; Brain Infarction; Ceftriaxone; Cerebrovascular Disorders; Disease Models, Animal; Excitatory Amino Acid Transporter 2; Glutamic Acid; Interleukin-6; Male; Nerve Growth Factors; Rats; Rats, Wistar; Regional Blood Flow; RNA, Messenger; Stroke; Survival Rate

Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay >or=1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).

Topics: Case-Control Studies; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Cerebrovascular Disorders; Citrobacter freundii; Critical Care; Cross Infection; Enterobacteriaceae Infections; Female; Humans; Length of Stay; Male; Middle Aged; Risk Factors

A 56-year-old Connecticut woman suffered multiple strokes 18 months after antibiotic treatment for early Lyme disease with facial palsy. Pleocytosis, intrathecal synthesis of anti-Borrelia burgdorferi antibody, and the response to antibiotic treatment substantiated the diagnosis of neuroborreliosis. This is the first report of stroke caused by Lyme disease acquired in North America.

Topics: Antibodies, Bacterial; Blotting, Western; Borrelia burgdorferi Group; Ceftriaxone; Cerebrovascular Disorders; Doxycycline; Enzyme-Linked Immunosorbent Assay; Female; Humans; Lyme Disease; Magnetic Resonance Imaging; Middle Aged