Scandinavian journal of infectious diseases
-
Scand. J. Infect. Dis. · Jan 2001
ReviewThe syndrome of inappropriate secretion of antidiuretic hormone and fluid restriction in meningitis--how strong is the evidence?
In patients with meningitis, fluid restriction is recommended to counter the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and to reduce cerebral oedema. However, any effects of an increased plasma level of ADH upon cerebral oedema would be due not to fluid retention but to hypoosmolality. In a literature review of fluid and electrolyte disturbances and the effect of fluid therapy in bacterial/tuberculous meningitis, the prevalence of hyponatraemia, hypoosmolality and SIADH varied considerably; apparently, non-osmotic stimuli for the secretion of ADH, e.g. intracranial hypertension and hypovolaemia, were present in most patients. ⋯ Furthermore, compared with maintenance therapy, fluid restriction did not improve outcome in a randomized controlled study. Thus, we find no evidence to support the use of fluid restriction in patients with meningitis. Fluid therapy in acute bacterial meningitis should aim at avoiding hypovolaemia and hypoosmolality based on the assumptions that (i) ADH is increased by non-osmotic stimuli; (ii) elevated ADH is less important for cerebral oedema than severe hypoosmolality, which may in itself induce or aggravate oedema; (iii) maintenance fluid therapy aiming at isoosmolality will not worsen neurological outcome; and (iv) hypovolaemia is difficult to detect, and detrimental for cerebral perfusion, in these patients.
-
Scand. J. Infect. Dis. · Jan 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA prospective, randomized, multicenter comparative study of clinafloxacin versus a ceftriaxone-based regimen in the treatment of hospitalized patients with community-acquired pneumonia.
In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). ⋯ Both drugs were tolerated. Treatment of hospitalized CAP patients with clinafloxacin is a reasonable choice, especially when a resistant pathogen is anticipated.
-
Scand. J. Infect. Dis. · Jan 2001
Comparative StudyLow sensitivity of serum procalcitonin in bacterial meningitis in adults.
Several studies have suggested high predictive values of serum procalcitonin (PCT) for the discrimination of bacterial and viral meningitis in children and adults. Here, we report PCT serum concentrations in 12 adults suffering from bacterial meningitis. PCT on admission was normal ( < or = 500 pg/ml) in 3 and between 500 and 1,000 pg/ml in 2 patients without evidence of concurrent bacterial infections. ⋯ PCT concentrations were higher with typical meningitis agents (pneumococci and meningococci 12,679 +/- 13,092 pg/ml vs. other bacteria 4048 +/- 9187 pg/ml, p = 0.041) whilst in nosocomial bacterial meningitis after neurosurgery (n = 3) serum PCT remained normal. We believe that PCT is of limited diagnostic value in adults suffering from bacterial meningitis, especially in cases due to unusual agents or of nosocomial origin. Elevated PCT in bacterial meningitis may indicate the presence of bacterial inflammation outside the central nervous system.
-
Scand. J. Infect. Dis. · Jan 2001
Case ReportsCulture-negative severe septic shock: indications for streptococcal aetiology based on plasma antibodies and superantigenic activity.
We present a severe septic shock syndrome patient with negative blood cultures. Acute and convalescent plasma samples from the patient were analysed for anti-streptolysin O titres, superantigen-neutralizing activity and presence of superantigenic activity. The plasma analyses implicated superantigen-producing Streptococcus pyogenes as the causative agent.
-
Salmonella virchow is generally considered to be one of the less invasive non-typhoidal Salmonellae species; however, several invasive cases have previously been reported. We report 3 cases of otherwise healthy children with S. virchow bacteraemia, monoarthritis and prevertebral abscess, only 1 of whom had previously had gastroenteritis. All 3 children responded to antibiotic regimens consisting of cefotaxime for 10 d, ceftriaxone for 3 weeks and ceftriaxone plus clindamycin for 4 weeks, respectively. In conclusion, S. virchow may be a more invasive serotype in immunocompetent children and present with a wider spectrum of manifestations than considered previously.