Athasit Vejjajiva

Neurological manifestations of gnathostomiasis

Neurological features of 24 patients with nervous system gnathostomiasis were reviewed. The commonest presenting features were radiculomyelitis or radiculomyelitis terminating with encephalitis, and subarachnoid haemorrhage. A primary encephalitic form was noted in 2 patients. The salient feature of the disease was a sudden onset of extremely severe radicular pain and/or headache followed by paralysis of the extremities and/or the cranial nerves. Migration signs were also the hallmark of nervous system gnathostomiasis. No single area of the nervous system was inaccessible to the highly invasive gnathostome lava. Multiplicity and/or rapid progress of lesions beyond the degree of cerebral oedema could only be explained by further migration of the parasite. Death occurred in 6 patients from direct extensive involvement of vital centres in the brain stem or from complications such as pneumonia or septicaemia. Multiple cranial nerve palsies were usually bad prognostic signs.

Radiculomyelitis complicating acute haemorrhagic conjunctivitis: A clinical study

Fourteen patients with radiculomyelitis following acute haemorrhagic conjunctivitis (AHC) were seen in Bangkok during October to December 1974. Most patients developed weakness of extremities 2 weeks after AHC. Prodromal symptoms consisted of fever and malaise for a few days, followed by the acute onset of root pain in the legs and flaccid paralysis. Knee and ankle reflexes were absent or diminished. Cerebrospinal fluid examination revealed lymphocytosis and an increase in protein. Electromyographic findings were consistent with anterior horn cell or motor root lesions. Ten of the 12 cases in which virological studies were performed showed definite serological evidence of AHC virus infection. Six patients received corticosteroid treatment but apart from relief of pain no significant improvement was seen. Motor weakness in 10 patients was less at the end of 2 months, but in 4 it remained unchanged. The occurrence of disabling neurological sequelae calls for effective public health control of AHC outbreak.

Peripheral Eosinophilia in the Course of Treatment of Cryptococcal Meningitis. Periphere Eosinophilic während der Therapie einer Cryptococcus-Meningitis

Summary:  In twelve consecutive patients suffering from cryptococcal meningitis the eosinophilia in peripheral blood was studied throughout the course of treatment with amphotericin B and 5‐fluorocytosine. A significant rise of the percentage of blood eosinophils could be observed in eight patients. Since amphotericin B has been shown to enhance contact sensitivity in mice and to have an activation potential on cells (lymphocytes) this might be a possible explanation for the rise in eosinophilia when this drug is administered. One could, however, submit an alternative explanatory hypothesis: namely, that this eosinophilia possibly reflects an activation of an underyling parasitic infection through the antifungal therapy.