Cerebrospinal fever

The meningococcus was first shown to be sensitive to sulfanilamide by English workers in 1936, and reports of successful treatment with it of cerebrospinal fever appeared in 1937. Mortality, which averaged 63% in the years 1931-36, fell more gradually than might have been expected The fig-... 

Patient 1. This 24-year-old male university student was brought to the emergency department at 1600 h by his roommate. He was delirious and had a depressed level of consciousness. Although he had been well the previous day, that morning he had complained of a fever, severe headache, severe neck and back stiffness, nausea, and vomiting. He had become progressively unwell over 7-8 hours. On physical examination he was acutely ill with a temperature of 40°C. He was delirious and had neck rigidity with severe resistance to any attempt to passively flex his neck. A CT scan of his brain was normal. A spinal tap was performed and cerebrospinal fluid (CSF) was removed it was cloudy. 

Intravenous ribavirin decreases mortality in patients with Lassa fever and other viral hemorrhagic fevers if started early. High concentrations inhibit West Nile virus in vitro, but clinical data are lacking. Clinical benefit has been reported in cases of severe measles pneumonitis and certain encephalitides, and continuous infusion of ribavirin has decreased virus shedding in several patients with severe lower respiratory tract influenza or parainfluenza infections. At steady state, cerebrospinal fluid levels are about 70% of those in plasma. 

A 25-year-old male AIDS patient has a fever of 102°F and complains of severe headaches during the past week. Staining of his cerebrospinal fluid with India ink reveals Crvptococcus neoformans. The patient is admitted to the hospital and is treated with ... 

Fever, cardiac murmur and vegetations are not invariably present in patients with infective endocarditis, and blood cultures are indicated in unexplained stroke particularly if there is raised erythrocyte sedimentation rate, mild anemia, neutrophil leukocytosis or a history of intravenous drug abuse. The cerebrospinal fluid (CSF) can be normal, but > 100 X 10 cells/l polymorphs is said to suggest endocarditis, although similar counts have been described in intracerebral hemorrhage and in hemorrhagic transformation of an infarct, but not in ischemic stroke (Powers 1986). 

Nigrovic LE, Chiang VW. Cost analysis of enteroviral polymerase chain reaction in infants with fever and cerebrospinal fluid pleocytosis. Arch Pediatr Adolesc Med 2000 154 817-21. 

The clinical findings in RDX intoxication may include fever rapid pulse hematuria due to effects on the prcximal tubules of the kidney proteinuria azotemia occasional mild anemia neutrophilic leukocytosis elevated SCOT, which, may explain the muscle soreness nitrites in the gastric juices and electroencephalographic abnormalities. There appears to be no liver involvement and cerebrospinal fluid is normal... 

After 10 days of antibiotic treatment, the patient was afebrile and cerebrospinal fluid was sterile, with normal protein and glucose levels. Drug treatment was discontinued, but after 2 days. she developed vomiting and fever to 40.5 °C. Cerebrospinal fluid culture was sterile, but counterimmuno-electrophoresis (CIE) was po.sitivefor H influenzae type b polyribosylribitol phosphate antigen. 

The pharmacokinetios of interferon is not well understood. Maximum levels in blood after intramuscular injection was obtained in 5 to 8 hours. Interferon does not penetrate well into cerebrospinal fluid (CSF). Oral administration of interferon does not indicate a detectable serum level, and as such, oral administration is olinioally ineffective. After intramuscular or suboutaneous injection, drug concentration in plasma is dose related. Clinioal use of interferon is limited to topioal administration (nasal sprays) for prophylaxis and treatment of rhinovirus infections. Adverse reaotions and toxioity include influenza-like syndrome of fever, ohills, headaohe, myalgias, nausea, vomiting, diarrhea, bone marrow suppression, mental confusion, and behavioral changes. Intranasal administration produoes mucosal friability, ulceration, and dryness. 

Chloramphenicol was the first broad-spectrum antibiotic to be used in medicine, but it came under a cloud when long-continued administration produced many cases of aplastic anaemia, which can be life endangering. Its use is now restricted to diseases where it is the most active known remedy, and which are likely to be cured quickly, within the safe period of the drug. Hence it is used to cure typhoid fever, bacterial meningitis, and anaerobic infections of the brain such as those caused by B.fragilis. It is the only common antibiotic to pass freely into the cerebrospinal fluid and to cross the blood—brain barrier. It also serves as a useful alternative to the tetracyclines in cholera and the rickettsial diseases such as typhus or Rocky Mountain spotted fever. 

Gopinathan (1973) thinks that the intracranial hypertension during nalidixic acid therapy is due to decreased absorption of cerebrospinal fluid. The range of side effects after oxolonic acid seems to be wider on the whole than after nalidixic acid nausea, vomiting, diarrhoea, spasms of the stomach, cardiopulmonary and neurological symptoms, and insomnia are prominent (Simon and Chermat 1977). Other less frequent adverse reactions to oxolonic acid are fever, rash, photosensitivity, palpitations, and a sense of tightness in the chest (Silverman 1981). Oxolonic acid should be given with food or antacids to minimize its side effects. 

A 34-year-old woman developed a severe headache and a high fever soon after cesarean section under spinal anesthesia with bupivacaine. Cerebrospinal fluid examination showed an increase in cell count but no organisms were found. 

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