ro13-9904 and Meningitis--Aseptic

Leptospirosis is a zoonotic illness caused by pathogenic spirochetes of the genus Leptospira. The disease spectrum ranges from a mild influenza-like presentation to a more serious Weil's syndrome. Leptospirosis rarely presents as a primary neurological syndrome. We report two cases of Leptospira borgpetersenii serovar Tarasssovi presenting as aseptic meningitis in Sri Lanka.. We describe case reports of two patients presenting as symptomatic aseptic meningitis due to neuroleptospirosis. Both patients had significant neurological involvement at presentation in the absence of common clinical features of leptospirosis. These patients were initially managed as bacterial or viral meningitis and leptospirosis was suspected due to a history of exposure to contaminated water. Subsequently, they were diagnosed to have neuroleptospirosis by positive Leptospira serology and both patients gained full recovery.. Our report highlights the importance of considering leptospirosis as a differential diagnosis in patients with aseptic meningitis in endemic settings. Obtaining a detailed occupational and recreational history is helpful in diagnosing neuroleptospirosis promptly. We report the association of Leptospira borgpetersenii serovar (sv.) Tarassovi (strain bakeri) in causing aseptic meningitis, which has not been reported to the best of our knowledge.

Topics: Acyclovir; Adult; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Drinking Water; Humans; Leptospira; Leptospirosis; Male; Meningitis, Aseptic; Serogroup; Sri Lanka; Treatment Outcome

Topics: Amoxicillin; Ceftriaxone; Central Nervous System Cysts; Diagnosis; Fever; Humans; Infant; Male; Meningitis, Aseptic; Neck Pain; Streptococcal Infections; Vaccination Refusal; Vancomycin

Topics: Acetaminophen; Adult; Ampicillin; Anti-Bacterial Agents; Azithromycin; Cefpodoxime; Ceftizoxime; Ceftriaxone; Dexamethasone; Drug Therapy, Combination; Fatigue; Female; Headache; Humans; Meningitis, Aseptic; Pneumonia; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin; Young Adult

Aseptic meningitis represents a diagnostic challenge for the clinician. Cytological and chemical parameters are key in the differential diagnosis. Hypoglycorrhachia is a strong predictor of a bacterial origin for aseptic meningitis. We report a 44-year-old male with a history of recurrent febrile headaches admitted with fever and delirium. The initial cerebrospinal fluid (CSF) analysis showed low glucose levels. Magnetic resonance imaging did not show abnormalities. The patient was discharged but was admitted again three weeks later with fever, headache and a stiff neck. The CSF was inflammatory with low glucose levels. Serology for brucellosis was positive. The patient was treated with ceftriaxone and rifampicin with a good clinical response.

Topics: Adult; Brucellosis; Ceftriaxone; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Meningitis, Aseptic

Topics: Amoxicillin; Anti-Bacterial Agents; Arthritis, Rheumatoid; Ceftriaxone; Drug Combinations; Female; Fever of Unknown Origin; Glucosamine; Humans; Meningitis, Aseptic; Middle Aged; Sulfasalazine; Treatment Outcome; Withholding Treatment

Topics: Aged; Aged, 80 and over; Ceftriaxone; Cerebrospinal Fluid; Fosfomycin; Humans; Hydrocortisone; Injections, Spinal; Male; Meningitis, Aseptic; Sciatica

Erythema migrans is the characteristic exanthem of Lyme disease. The rash initially occurs at the site of inoculation; subsequently satellite lesions can occur. We describe an adolescent girl in whom the rash appeared after the initiation of ceftriaxone therapy for aseptic meningitis. We suggest that the occurrence of rash in this patient was a result of liberated toxin from local bacterial lysis.

Topics: Adolescent; Borrelia burgdorferi; Ceftriaxone; Cephalosporins; Erythema; Female; Humans; Lyme Disease; Meningitis, Aseptic

Meningeal involvement in leptospiral infection is quite common, usually mild and often overlooked. In contrast, cases of isolated involvement of the central nervous system, including aseptic meningitis, have been reported only rarely. A case of a patient with acute aseptic meningitis caused by Leptospira australis serovar bratislava is reported. This is believed to be the first report of aseptic meningitis due to Leptospira australis. This case indicates the need to consider human leptospirosis in the differential diagnosis of aseptic meningitis.

Topics: Adult; Agglutination Tests; Antibodies, Bacterial; Ceftriaxone; Diagnosis, Differential; Humans; Leptospira; Leptospirosis; Male; Meningitis, Aseptic

Topics: Adult; Ceftriaxone; Diagnostic Errors; Female; Headache; Humans; Lyme Disease; Male; Meningitis, Aseptic; Physical Examination; Salicylates