zithromax and Stroke

A 39-year-old Philipino man presented with acute onset fever and headache. Neurological examination was normal except for neck stiffness. There was no history of chest pain, cough or breathlessness. Cerebrospinal fluid (CSF) showed a mild increase in protein with normal sugar and lymphocytic pleocytosis. CSF PCR for herpes simplex and varicella zoster virus was negative. He developed acute right haemiplegia a week after hospitalisation. MRI showed acute infarct in the left centrum semiovale. His angiogram showed aneurysm in the left subclavian artery and aortic arch. The mycoplasma antibody test came positive with very high titres, while rest of the workup was negative. He was treated with azithromycin and his symptoms improved completely.He was asymptomatic on follow-up after a month. His repeat immunoglobulin G mycoplasma antibody titre showed elevation. Mycoplasma infection is a treatable cause of meningoencephalitis and stroke secondary to vasculitis. Arterial aneurysms are known to occur with mycoplasma infection although rare.

Topics: Adult; Aneurysm; Anti-Bacterial Agents; Aortic Aneurysm; Azithromycin; Humans; Male; Meningoencephalitis; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Stroke; Subclavian Artery

To develop novel and effective treatments for ischemic stroke, we investigated the neuroprotective effects of the macrolide antibiotic azithromycin in a mouse model system of transient middle cerebral artery occlusion. Intraperitoneal administration of azithromycin significantly reduced blood-brain barrier damage and cerebral infiltration of myeloid cells, including neutrophils and inflammatory macrophages. These effects resulted in a dose-dependent reduction of cerebral ischemic damage, and in a remarkable amelioration of neurological deficits up to 7 days after the insult. Neuroprotection was associated with increased arginase activity in peritoneal exudate cells, which was followed by the detection of Ym1- and arginase I-immunopositive M2 macrophages in the ischemic area at 24-48 h of reperfusion. Pharmacological inhibition of peritoneal arginase activity counteracted azithromycin-induced neuroprotection, pointing to a major role for drug-induced polarization of migratory macrophages towards a protective, non-inflammatory M2 phenotype.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Brain Ischemia; Disease Models, Animal; Dose-Response Relationship, Drug; Macrophage Activation; Macrophages; Male; Mice; Mice, Inbred C57BL; Neuroprotective Agents; Stroke

Repurposing azithromycin has recently emerged as a promising strategy for the acute treatment of ischemic stroke. The mechanism of neuroprotection depends on the ability of this macrolide to promote polarization of microglia/macrophages towards beneficial M2 phenotypes. The immunomodulatory and anti-inflammatory effects of azithromycin, well documented in chronic inflammatory airway diseases, have been ascribed to the inhibition of the transcription factors nuclear factor (NF)-κB and activator protein (AP)-1. Since these inflammatory transcription factors are positively regulated by poly(ADP-ribose) polymerase (PARP)-1, an enzyme actively involved in ischemic brain injury, we have investigated whether the neuroprotective properties of azithromycin in ischemic stroke involve upstream modulation of PARP-1. Administration of a single dose of this macrolide antibiotic upon reperfusion reduced, to a similar extent in wild type and PARP-1 knockout mice, infarct brain damage produced by transient occlusion of the middle cerebral artery. Moreover, we demonstrated the lack of effects of azithromycin on PARP-dependent death of HeLa cells, as well as on activity of purified PARP-1 and PARP-2. Thus, azithromycin protects mice against ischemic stroke injury through a mechanism independent of PARP activation.

Topics: Animals; Azithromycin; Brain Ischemia; Cell Death; Gene Knockout Techniques; Immunomodulation; Male; Mice; Neuroprotective Agents; Poly (ADP-Ribose) Polymerase-1; Stroke

Cat-scratch disease is a common disease, occurring in an estimated 24,000 patients annually in the United States, and is one of the most common causes of chronic lymphadenitis in children. A wide array of neurologic complications occurs as a result of cat-scratch disease. However, there have been no reports of acute-onset, self-resolving, recurrent, expressive aphasia, as we report here in an adolescent boy. In our case, establishing the diagnosis of cat-scratch encephalopathy saved time and resources and afforded the family a benign diagnosis. Cat-scratch encephalopathy must be considered in the differential diagnoses when pediatric patients present with unusual neurologic symptoms.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Aphasia, Broca; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Cats; Diagnosis, Differential; Humans; Male; Recurrence; Stroke; Treatment Outcome

Topics: Administration, Oral; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Azithromycin; Cloprostenol; Eye Diseases; Glaucoma, Open-Angle; Humans; Macular Degeneration; Ocular Hypertension; Ranibizumab; Recurrence; Risk Factors; Stroke; Trachoma; Travoprost