ro13-9904 and Encephalitis

Meningitis and encephalitis are medical emergencies. Patients need prompt evaluation and immediate empiric therapy to reduce the likelihood of fatal outcomes and chronic neurological sequelae. Conjugate bacterial vaccines have significantly reduced the incidence of bacterial meningitis, especially in children. As the results of changes in patterns of bacterial drug sensitivity, ceftriaxone is now part of the recommended empiric treatment for bacterial meningitis and should be administered as early as possible. Neuroimaging delays the treatment of meningitis and is not needed in most cases. Adjunctive corticosteroid therapy is of benefit for many patients with meningitis and should be initiated in most adults before antibiotic therapy. Molecular testing can assist the specific diagnosis of encephalitis and should be based on the exposure history and geographic risk factors relevant to the patient, but non-infectious causes of encephalitis are also common. Empiric therapy for encephalitis should be directed at the most frequently identified infectious pathogen, herpes simplex virus type 1 (ie, intravenous aciclovir). Vaccines can protect against the major pathogens of childhood infections (measles, mumps, rubella, polio, varicella viruses), influenza viruses, and exotic pathogens that cause meningitis and encephalitis (rabies, Japanese encephalitis, dengue, yellow fever, tick-borne encephalitis viruses, Mycobacterium tuberculosis).

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Bacterial Vaccines; Ceftriaxone; Community-Acquired Infections; Encephalitis; Humans; Incidence; Meningitis; Vaccines, Conjugate

A 45-year-old man was presented at the emergency department with altered neurological status and a 1-day history of diarrhoea and fever. The patient's sexual history revealed multiple male partners. As bacterial meningitis or viral encephalitis was suspected, treatment was started accordingly. Cerebrospinal fluid investigations only showed a slight increase of leucocytes, and microbiological studies remained negative. Stool culture revealed

Topics: Acyclovir; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Drug Therapy, Combination; Dysentery, Bacillary; Encephalitis; Feces; Fever; Humans; Male; Middle Aged; Sexual and Gender Minorities; Shigella flexneri; Treatment Outcome; Unsafe Sex

Although it is an orphan disease, isolated central nervous system Whipple's disease is one of the "must be known" conditions in neurology because it belongs to the list of "treatable disorders". Here, we present two cases which highlight the importance of early diagnosis. Additionally, we provide a discussion on up to date diagnostic approach to this life-threatening disorder.

Topics: Adult; Anti-Bacterial Agents; Ataxia; Ceftriaxone; Central Nervous System Infections; Encephalitis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Parkinson's disease is a neurodegenerative disorder characterized by the loss of dopamine neurons in the substantia nigra pars compacta along with decreased striatal dopamine levels, and consequent extra pyramidal motor dysfunctions occur. It has been reported that Ceftriaxone, a β-lactam antibiotic recently had shown to have neuroprotective effects in various neurodegenerative disorder. Therefore the present study was designed to investigate the effects of Ceftriaxone (CFX) in a MPTP model of Parkinson in rats. MPTP was administered intranigrally for the induction of PD in Male Wistar rats. Ceftriaxone (100 and 200mg/kg) and Ropinirole (1.5 and 3mg/kg) were given intraperitonially, after induction of Parkinson's disease for 14 days. Different behavioral performance was carried on 1st, 14th, 21st, 28th consecutive days and biochemical parameters were estimated on 28th day. Central administration of MPTP showed significant impairment of motor behavior and marked increase of oxidative damage and neuro-inflammmation in rats. However, post treatment with Ceftriaxone (100 and 200mg/kg) significantly improved the motor deficits and attenuated the oxidative damage indicating decreased rise of LPO and nitrite concentration and restored the decreased activities of endogenous antioxidant enzyme (Glutathione, Catalase, SOD). In addition Ceftriaxone also attenuates the pro-inflammatory cytokines like TNF-α and IL-β in striatum region of MPTP induced PD in rats. Ropinirole (1.5mg/kg) pretreatment with sub-effective dose of a Ceftriaxone (100mg/kg) had significantly enhanced the protective effect of Ceftriaxone as compare to its effect with per se group. These results suggested that Ceftriaxone exhibit Neuroprotective effect by mediating brain antioxidant defense mechanism and by up regulating of dopaminergic pathway and down regulation of glutamatergic pathway.

Topics: Animals; Ceftriaxone; Encephalitis; Indoles; Male; Motor Activity; MPTP Poisoning; Neuroprotective Agents; Oxidative Stress; Rats; Rats, Wistar; Rotarod Performance Test; Substantia Nigra

The objective of this study is to characterize the common risk factors, clinical presentation, imaging findings, treatment and outcome of nocardial infection.. A retrospective cohort study. We reviewed the charts of all patients with nocardiosis in the Chaim Sheba Medical Center, a tertiary medical center in Israel, between the years 1996 and 2011.. A total of 39 patients who had positive culture of Nocardia were analyzed. The majority of our patients were immunocompromised (74.5%), mostly due to corticosteroid therapy. None had HIV/AIDS. The clinical presentation was either acute or a chronic smoldering illness. The three major clinical syndromes were pleuropulmonary, neurological and skin/soft tissue infection about 20.5% each. Pathology in the lungs was seen in most of the patients by CT scan; discrete nodules and wedge shaped pleural based consolidations were the most frequent findings. Brain lesions consistent with abscesses were detected in 10 patients by brain imaging. Some cases had relapsing disease in spite of antimicrobial treatment. 25% of examined isolates were resistant to trimethoprim/sulfamethoxazole. The duration of intravenous antimicrobial treatment ranged from one month to over a year in the severe cases. One year mortality rate was 32%.. Nocardiosis requires a high clinical index of suspicion in order to diagnose and treat promptly. Disease extent and bacterial susceptibility have important implications for prognosis and treatment.

Topics: Adrenal Cortex Hormones; Adult; Aged; Amikacin; Carbapenems; Ceftriaxone; Cohort Studies; Encephalitis; Female; Humans; Immunocompromised Host; Israel; Male; Middle Aged; Nocardia Infections; Pleuropneumonia; Retrospective Studies; Risk Factors; Skin Diseases, Bacterial; Soft Tissue Infections; Tertiary Care Centers; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 23-year-old gentleman with no significant medical history other than obesity was admitted with a history of balance problems, double vision and strange behaviour following a fall from bed. Systems examination was unremarkable. The patient was given intravenous acyclovir and intravenous ceftriaxone given the suspicion of encephalitis/meningitis. Investigations including routine bloods, CT/MRI Head and lumbar puncture were unremarkable. Within 48 h of commencing intravenous acyclovir, there was a marked deterioration in renal function. On stopping acyclovir therapy, renal function improved back to baseline. No other cause for deterioration in renal function was identified. The most likely cause for acute renal failure was secondary to acyclovir therapy. This has been well documented and is due to intratubular crystal precipitation. Moreover, in this case nephrotoxicity is likely secondary to the large boluses of intravenous acyclovir that had been given as prescribed according to the total body weight.

Topics: Accidental Falls; Acute Kidney Injury; Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Encephalitis; Humans; Male; Meningitis; Obesity; Young Adult

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, but this organism can also affect almost every organ system besides the lung. Neurological manifestations (meningitis, encephalitis, transverse myelitis, Guillain-Barrè syndrome) are the most frequent extrapulmonary complications of Mycoplasma pneumoniae. We report a case of a immunocompetent child affected by encephalitis caused by Mycoplasma pneumoniae.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Clarithromycin; Dexamethasone; Drug Therapy, Combination; Electroencephalography; Encephalitis; Glucocorticoids; Humans; Immunocompetence; Male; Mycoplasma Infections; Mycoplasma pneumoniae; Treatment Outcome

Topics: Adjuvants, Immunologic; Animals; Anti-Bacterial Agents; Bartonella henselae; Biomarkers; Blood Sedimentation; C-Reactive Protein; Cat-Scratch Disease; Cats; Ceftriaxone; Child; Clarithromycin; Drug Therapy, Combination; Encephalitis; Erythromycin; Female; Humans; Lymphadenitis; Minocycline; Thienamycins; Treatment Outcome

Topics: Adult; Animals; Antibiotics, Antitubercular; Antibodies, Bacterial; Bartonella henselae; Cat-Scratch Disease; Cats; Ceftriaxone; Cephalosporins; Encephalitis; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Optic Neuritis; Retinitis; Rifampin

Morbidity in rubella is generally mild, and neurological complications are rare, varying from 1:6000-1:24,000. We describe an 11-year-old girl with severe manifestations of rubella encephalitis. The onset of encephalitis most often occurs within 1-6 days after development of the typical rash. Neurological features vary and include encephalitis, carotid artery thrombosis, myelitis, optic neuritis, Guillain-Barre syndrome, and peripheral neuritis. Rubella should be considered in the differential diagnosis of encephalitis despite the current vaccination program in Israel. Such cases should be prevented by encouraging widespread early childhood vaccination.

Topics: Acyclovir; Ceftriaxone; Child; Diagnosis, Differential; Encephalitis; Female; Humans; Rubella

In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.

Topics: Acute Disease; Antibodies, Bacterial; Borrelia burgdorferi Group; Ceftriaxone; Chronic Disease; Diagnosis, Differential; Encephalitis; Humans; Immunoglobulin G; Lyme Disease; Male; Meningitis; Middle Aged; Neurocognitive Disorders; Polyradiculopathy; Schizophrenia; Syndrome

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

Topics: Cefotaxime; Ceftriaxone; Cerebral Ventricles; Child; Child, Preschool; Encephalitis; Humans; Infant; Infant, Newborn; Kinetics; Meningitis

Topics: Amikacin; Cefotaxime; Ceftriaxone; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Encephalitis; Humans; Hydrocephalus; Injections, Intraventricular; Kanamycin