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ABSTRACT: INTRODUCTION: The clinical and MR imaging features of neurosyphilis are highly varied. In this study, we describe the spectrum of the imaging findings in patients with neurosyphilis. METHODS: The MR imaging observations of 35 patients diagnosed to have neurosyphilis on the basis of cerebrospinal fluid reactive for the Venereal Disease Research Laboratory test were reviewed. RESULTS: All the 35 patients, including four with human immunodeficiency virus coinfection, met the CDC diagnostic criteria for neurosyphilis. Patients were classified into three groups: (1) neuropsychiatric, (2) meningovascular, and (3) myelopathic, based on the dominant clinical manifestations. Fourteen patients with neuropsychiatric manifestations showed diffuse cerebral atrophy (14), parenchymal signal changes in the mesial temporal region (2) and temporal and basifrontal regions (1), infarcts (3), and nonspecific white matter changes (3). Eleven patients with meningovascular form showed infarcts (6), diffuse cerebral atrophy (3), signal changes in the mesial temporal region (3), sulcal exudates (1), progressive multifocal leukoencephalopathy (1), and a mass surrounding the carotid sheath (1). Spine imaging in ten patients with myelopathy showed long-segment signal changes (5), contrast enhancement (2), and dorsal column involvement (2). Three of these patients had normal spinal study. Six patients in the myelopathic group also underwent brain MRI that showed signal changes in the temporal region (2) and frontal region (1), multiple infarcts (1), and enhancing hypothalami (1). Three patients had normal study. CONCLUSION: MRI abnormalities in neurosyphilis are protean and mimic of many other neurological disorders and thus require a high index of suspicion to reduce diagnostic omissions.
Neuroradiology 12/2012; · 2.82 Impact Factor
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ABSTRACT: We report a 65-year-old woman who manifested with progressive cognitive impairment, abnormal behavior, slurred speech, inability to carry out activities with right upper limb, gait disturbances, emotional liability, and double incontinence that evolved progressively over the last 8 months. A clinical syndrome of "rapidly progressive dementia" was considered. The MRI of brain was unremarkable except for small para third ventricular enhancing lesion was detected in the left thalamic region. There was bi/tri-phasic sharp waves in the routine scalp EEG occurring at periodically 1.5-2.0 Hz, mimicking Creutzfeldt-Jakob disease (CJD). She was later diagnosed to have carcinomatous meningitis based on cerebrospinal fluid (CSF) cytology. This case is being discussed for rarity and interesting EEG observations in patients with carcinomatous meningitis and to highlight the importance of CSF cytology in an appropriate clinical setting. One needs to be careful in concluding CJD as possible diagnosis in such scenario.
Journal of neurosciences in rural practice. 05/2012; 3(2):207-9.
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03/2012; , ISBN: 978-953-51-0383-7
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ABSTRACT: Septic cavernous sinus thrombosis (CST) is an uncommon clinical syndrome. Although Staphylococcus aureus ( S aureus ) is the most common bacterial pathogen causing CST , it is infrequent as a cause of meningitis. We report the first case of CST and meningitis from Bengaluru, Karnataka, caused by community-acquired epidemic methicillin resistant Staphylococcus aureus -15 (EMRSA-15), in a previously healthy individual without known risk factors; the patient recovered following treatment with vancomycin. The isolate was genotyped as belonging to staphylococcal cassette chromosome mec type IV and sequence type 22 and carried the panton-valentine leucocidin gene. It is the first Indian EMRSA-15 disease isolate from a case of meningitis. EMRSA-15 has been a major problem in hospitals in UK and it is a cause for great concern in Indian hospitals too.
Indian Journal of Medical Microbiology. 01/2010;
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Shrijeet Chakraborti,
Anita Mahadevan,
Aparna Govindan, S Nagarathna,
Vani Santosh,
T C Yasha,
B Indira Devi,
B A Chandramouli,
Jerry M E Kovoor,
A Chandramuki,
S K Shankar
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ABSTRACT: Central nervous system tuberculosis is still one of the leading causes of morbidity in the developing world, and tuberculous abscess is one of its uncommon manifesting forms. It closely mimics a pyogenic abscess clinically, radiologically, and histologically. An accurate diagnosis is imperative due to therapeutic implications. In this study, 21 cases of tuberculous abscesses encountered over a period of 13 years (1995-2007) were reviewed to study the clinical, radiological, and histopathological spectrum of the disease. The presence of palisading epithelioid cells and sheets of foamy histiocytes, enclosing a neutrophillic exudate rich in fibrin with nuclear debris, were clues as to suspicion of a tuberculous abscess. The demonstration of acid fast bacilli in the wall of the abscess or necrotic contents by microscopy or culture is essential to confirm the diagnosis of tuberculous abscess. A high index of clinical suspicion is necessary particularly in countries endemic for tuberculosis to ensure an accurate diagnosis and application of an appropriate therapy.
Pathology - Research and Practice 08/2009; 205(12):815-22. · 1.21 Impact Factor
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Indian Journal of Pathology and Microbiology. 01/2009;
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ABSTRACT: Neurosyphilis has protean clinical manifestations, including epilepsy. However, there is paucity of literature providing details regarding seizures. The aim of the study was to analyze the clinical profile and brain imaging features of 30 patients of neurosyphilis, and to evaluate the predictors and the outcome of seizures in this subgroup.
Among the 119 patients (M:F:: 84:35) of neurosyphilis, evaluated over 6 years, 30 patients (M:W::23:7, age: 37.5+/-10.1 years, duration of illness: 11.9+/-20.1 months) were reported to have seizures. CSF-VDRL was positive in all. In addition, HIV serology was positive in 2/20.
Seizure was the dominant symptom in all and lone manifestation in two patients. None had history of epilepsy. Their seizure profile was: generalized (17), partial (8), and status epilepticus (5). Concomitant manifestations were encephalopathy (7), meningitis (7), dementia (6), behavioral disturbances (4), stroke (2), and optic atrophy (1). CSF study revealed pleocytosis in 24 (34.6+/-51.5/cu mm) and raised protein in 20 (67+/-33.3mg%). CT scan was abnormal in 26 patients and revealed diffuse atrophy in all and focal hypodensities in 5 patients. MRI of brain (6) showed features of ischemia (2), meningeal enhancement (1) and white matter (1) and medial temporal (2) signal changes. Three patients had reversible periodic lateralized epileptiform discharges (PLEDs), without structural lesion. Nineteen patients received penicillin and/or ceftriaxone. At a mean follow up of 6.7+/-9.4 months, 13/17 had variable improvement. Nine patients required polytherapy and seizures remained uncontrolled in five patients.
Symptomatic seizures due to neurosyphilis are frequent, may have diverse underlying mechanism(s) and rarely can be the lone manifestation. In view of availability of specific therapy for syphilis, a high index of suspicion is recommended.
Seizure 07/2008; 17(8):711-6. · 1.80 Impact Factor
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International Journal of Infectious Diseases 05/2008; 12(5):560-2. · 1.94 Impact Factor
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ABSTRACT: Pseudomonas aeruginosa (P aeruginosa) is one of the most common nosocomial pathogens. We report our experience of a device-related outbreak of postoperative ventriculitis caused by P aeruginosa thus initiating investigation of the unusual occurrence. Five neurosurgical patients were affected, postoperatively. The investigations entailed extensive screening of the common sources of contamination for colonization of P aeruginosa. Sterilized instruments used for surgery, including the ultrasonic aspirator (USA) sets and other hollow devices, were randomly sampled and cultured. Conventional culture methods yielded P aeruginosa, with almost similar antibiotic sensitivity pattern in all the patients and the ultrasonic aspirator, clinching the source of contamination. Routine surveillance, identification of unusual patterns, molecular epidemiological typing would be helpful in quick control of outbreaks of postoperative infections.
Indian Journal of Pathology and Microbiology 05/2008; 51(2):301-3. · 0.68 Impact Factor
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The Journal of the Association of Physicians of India 04/2008; 56:202.
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ABSTRACT: Drug-resistant tuberculosis is an increasing problem worldwide. There are few reports of drug susceptibility patterns of Mycobacterium tuberculosis isolated from cases of tuberculous meningitis. A 5-year retrospective study aimed at analysing the drug susceptibility profile of M. tuberculosis isolated from tuberculous meningitis cases was conducted. A total of 366 isolates were analysed. Among these, 301 (82.2%) were sensitive to all the four primary drugs tested, while 65 (17.8%) showed resistance. There were 46 (12.5%) isolates resistant to isoniazid (INH), while 9 (2.4%) demonstrated multidrug resistance. These data suggest that multidrug resistance in tuberculous meningitis is not yet a serious problem. However, a periodic review is required to ascertain the global incidence of drug-resistant tuberculous meningitis.
The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 02/2008; 12(1):105-7. · 2.73 Impact Factor
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ABSTRACT: Pseudomonas aeruginosa (P aeruginosa) is one of the most common nosocomial pathogens. We report our experience of a device-related outbreak of postoperative ventriculitis caused by P aeruginosa thus initiating investigation of the unusual occurrence. Five neurosurgical patients were affected, postoperatively. The investigations entailed extensive screening of the common sources of contamination for colonization of P aeruginosa . Sterilized instruments used for surgery, including the ultrasonic aspirator (USA) sets and other hollow devices, were randomly sampled and cultured. Conventional culture methods yielded P aerugino sa, with almost similar antibiotic sensitivity pattern in all the patients and the ultrasonic aspirator, clinching the source of contamination. Routine surveillance, identification of unusual patterns, molecular epidemiological typing would be helpful in quick control of outbreaks of postoperative infections
Indian Journal of Pathology and Microbiology. 01/2008;
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ABSTRACT: Drug-resistant tuberculosis is an increasing problem worldwide. There are few reports of drug susceptibility patterns of Mycobacterium tuberculosis isolated from cases of tuberculous meningitis. A 5-year retrospective study aimed at analysing the drug susceptibility profile of M. tuberculosis isolated from tuberculous meningitis cases was conducted. A total of 366 isolates were analysed. Among these, 301 (82.2%) were sensitive to all the four primary drugs tested, while 65 (17.8%) showed resistance. There were 46 (12.5%) isolates resistant to isoniazid (INH), while 9 (2.4%) demonstrated multidrug resistance. These data suggest that multidrug resistance in tuberculous meningitis is not yet a serious problem. However, a periodic review is required to ascertain the global incidence of drug-resistant tuberculous meningitis.
The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 12/2007; 12(1):105-107. · 2.73 Impact Factor
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ABSTRACT: To evaluate the role of the radiometric BACTEC 460TB system and the conventional Lowenstein-Jensen (LJ) medium for isolation of M. tuberculosis from cerebrospinal fluid (CSF) samples of tuberculous meningitis (TBM) patients.
CSF specimens (n=2325) from suspected TBM patients were processed for isolation of mycobacteria by inoculating BACTEC 12B medium and the LJ medium. The isolation of mycobacteria in both media was confirmed by microscopy and biochemical identification. Drug sensitivity testing for the anti-TB drugs was carried out by BACTEC radiometric method.
Among the total 2325 CSF specimens processed by both methods, M. tuberculosis was isolated from 256 specimens. The isolation rates were 93% and 39% for the BACTEC system and LJ medium respectively. Both the media supported growth in 32% of the culture-positive specimens. BACTEC system alone yielded growth in 61% and LJ alone in 7%, of the culture-positive specimens. Among 205 isolates tested for drug susceptibility 81% were sensitive to all the drugs tested and 19% were resistant.
The BACTEC 460TB system provides a highly sensitive and rapid tool for the isolation and drug susceptibility testing of M. tuberculosis, from CSF of TBM patients. Use of a solid medium in conjunction with the BACTEC 12B medium is essential for optimal recovery for M. tuberculosis from CSF specimens.
Indian Journal of Medical Microbiology 08/2007; 25(3):236-40. · 0.99 Impact Factor
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ABSTRACT: Despite the recent resurgence in reports of invasive Group A Streptococcal (GAS) infections worldwide, it remains a rare cause of pyogenic meningitis both in children and adults. We report a case of fatal GAS meningitis in a healthy adult emphasizing the need for clinicians to be aware of its fulminant course, prompting early diagnosis and treatment. There is also a need to consider postexposure chemoprophylaxis in close contacts of such cases.
Indian Journal of Medical Microbiology 05/2007; 25(2):169-70. · 0.99 Impact Factor
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ABSTRACT: Ten years retrospective study to evaluate the bacteriological spectrum of community acquired acute bacterial meningitis (CAABM).
Cerebrospinal fluid (CSF) samples from 385 clinically suspected cases of pyogenic meningitis were processed for cell counts, cytospin Gram stain, culture, antigen detection by latex agglutination (LAT) and antibiotic susceptibility test. Eighteen of these CSF samples were also subjected to a polymerase chain reaction (PCR) assay for detection of pneumococcal DNA.
The etiological agent could be identified in 284 (73.8%) of the total 385 cases by culture and/or smear and /or LAT. Streptococcus pneumoniae was the predominant pathogen accounting for 238 (61.8%) cases. Haemophilus influenzae and Neisseria meningitidis accounted for 7 (1.8%) and 4 (1%) cases respectively. Other gram negative bacilli, Streptococcus spp. and Staphylococcus aureus were isolated from 19 (4.9%), 9 (2.3%) and 7 (1.8%) cases respectively.
Streptococcus pneumoniae remains the major aetiological agent of CAABM both in adults and children in our set-up. No penicillin resistance was detected among the isolates. Further research should focus on preventable aspects of CAABM, especially pneumococcal vaccines, to help reduce the disease burden.
Indian Journal of Medical Microbiology 05/2007; 25(2):108-14. · 0.99 Impact Factor
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ABSTRACT: Tuberculous meningitis (TBM) is the commonest form of neurotuberculosis in the Indian subcontinent. Rapid laboratory confirmation of TBM is important for the institution of early treatment and to avoid associated morbidity and mortality. The polymerase chain reaction (PCR) is the most widely applied alternative rapid diagnostic technique for TBM.
To evaluate the efficacy of an in-house developed IS6110 uniplex PCR (uPCR) in the diagnosis of TBM.
A prospective, blinded study was conducted in a large sample base of 677 cerebrospinal fluid samples from 677 patients with clinically suspected TBM.
All culture-positive samples (n = 136) were positive (100%) by the PCR assay. The assay was found to be positive in 70% (n = 541) of the samples with a clinical diagnosis of TBM. The assay had an observed sensitivity of 76.37% (negative predictive value 59.90%) and a specificity of 89.18% (positive predictive value 94.69%). A diagnostic accuracy of 80% (kappa 0.57) was seen in patients with a clinical diagnosis of TBM. Statistical significance was observed, as patients with a clinical diagnosis of TBM were found to be 9.38 times more likely to be PCR-positive (OR 9.38, chi2 = 149.94, P < 0.001).
The performance of the in-house IS6110 uPCR assay merits its use as a sensitive and specific tool for the rapid diagnosis of TBM.
The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 02/2007; 11(2):209-14. · 2.73 Impact Factor
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ABSTRACT: Despite the recent resurgence in reports of invasive Group A Streptococcal (GAS) infections worldwide, it remains a rare cause of pyogenic meningitis both in children and adults. We report a case of fatal GAS meningitis in a healthy adult emphasizing the need for clinicians to be aware of its fulminant course, prompting early diagnosis and treatment. There is also a need to consider postexposure chemoprophylaxis in close contacts of such cases.
Indian Journal of Medical Microbiology. 01/2007;
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ABSTRACT: Cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality in patients with AIDS. Among the human immunodeficiency virus (HIV)-seropositive subjects, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection. Current trends are changing due to the marked improvement of quality and length of life produced by highly active antiretroviral therapy (HAART). The introduction of generic HAART in India has resulted in an increase in the number of individuals getting treatment for HIV infection, as the cost of highly active antiretroviral therapy (HAART) has decreased 20- fold. Cryptococcal meningitis occurs in non-HIV patients who are immunodeficient due to diabetes, cancer, solid organ transplants, chemotherapeutic drugs, hematological malignancies etc and rarely in healthy individuals with no obvious predisposing factors. Diagnosis of cryptococcal meningitis is fairly straightforward once the diagnosis is considered in the differential diagnosis of chronic meningitis. Treatment of a patient with cryptococcal infection is a challenge for both the physician and the patient, but rewarding, as many would recover with timely and adequate antifungal therapy.
Neurology India. 01/2007;
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ABSTRACT: Background : Central nervous system (CNS) cladosporiosis is a rare infection caused by Cladophialophora bantiana. It has varied presentation and poor outcome. Most of the available data in the literature are reviews of individual case reports. Objective : To describe the clinical, radiological and mycological features of 10 cases of C. bantiana managed at a single tertiary center. To analyze the various treatment options, factors associated with outcome, and to review the relevant literature. Materials and Methods: This is a retrospective study of 10 patients with CNS cladosporiosis managed at National Institute of Mental Health and Neurosciences from 1979 to 2006. It is a descriptive study. The case records were reviewed for clinical presentation, radiological features, management and outcome. Only those patients in whom the fungus could be isolated on culture were included in the study. Results : The age of the patients ranged from three to 42 years. Nine patients presented with features of space-occupying lesion and one patient with chronic meningitis. There were no specific clinical or radiological features. None of patients had impaired immune status. This infection presented as two pathomorphological forms - diffuse meningoencephalitis and focal abscesses. Burr hole tapping and excision are the surgical options. Both patients with burr hole tapping required excision of abscess subsequently. Two out of seven patients with abscess expired compared to all three patients with diffuse meningoencephalitis who expired. Recurrences occurred in four of the five patients following excision of the abscess. Combination antifungal treatment had better result than monotherapy. The outcome was poor with survival of only 50%. Conclusions : Thorough microbiological examination is required to diagnose CNS infection caused by C. bantiana . The outcome is better in patients with abscess. Excision of the abscess followed by combination antifungal therapy results in better outcome. Close follow-up is required due to high risk of recurrence.
Neurology India. 01/2007;
