Paul F. Wehrle

Meningitis due to Listeria monocytogenes. A review of 25 cases.

Abstract Twenty-five patients with bacteriologically proved Listeria monocytogenes meningitis were studied. Twenty-one were male. Nine of the 25 were neonates, and 11 were 55 years of age or older. Twenty-four patients received either ampicillin or penicillin, at times in combination with other antibiotics. One of the ampicillin-treated patients, and six of the penicillin-treated patients died. Recovery of the patient from meningeal infection seemed to correlate best with an initial cerebrospinal-fluid glucose level over 30 mg per 100 ml. These data, like those already appearing in the literature, suggest that intravenous ampicillin may be the therapy of choice, from the standpoint of both superior efficacy and relative lack of toxicity.

H. INFLUENZAE MENINGITIS: A CONTROLLED STUDY OF TREATMENT WITH AMPICILLIN.

gitis, however, the drug was found in brain almost exclusively in animals with intensive signs of meningitis. Ampicillin, particularly in large doses, had a distinct therapeutic effect in experimental Hemophilus meningitis The pathological changes in the meninges corresponded to the clinical picture. In experiments with /3-streptococci and Haemophilus influenze, however, milld changes were discernible even before signs of meningitis had appeared.

Comparative Trial of Carbenicillin and Ampicillin Therapy for Purulent Meningitis

A randomized therapeutic trial of carbenicillin (CB) or ampicillin (AMP) in purulent meningitis was performed in 86 pediatric and adult patients (41 Haemophilus influenzae, 22 Streptococcus pneumoniae, 13 Neisseria meningitidis, and 10 of unknown etiology). All isolates, incuding H. influenzae, were susceptible to CB and AMP. Median cerebrospinal fluid (CSF) antibiotic concentrations were 0.85 and 1.60 μg/ml for CB and AMP, respectively, during administration of daily doses of 400 mg/kg and 0.65 and 0.45 μg/ml, respectively, on daily doses of 200 mg/kg. Higher CSF concentrations, up to a median concentration of 4.5 μg/ml, were observed in patients with CSF protein concentrations ≥75 mg/100 ml. Clinical responses were equivalent on either antibiotic regimen. Among AMP patients (45), 8 had significant residua and 3 died; among CB patients (41), 5 had residua and none died. However, 38% of H. influenzae patients treated with CB had positive CSF cultures on day 1 follow-up lumbar punctures, compared with only 5.8% of AMP patients with H. influenzae. The significance of a delay of CSF sterilization among CB-treated patients is unknown, since there was no correlation between persistence of hemophilus organisms and the frequency of adverse outcome. AMP and CB are equivalent for the treatment of bacterial meningitis due to susceptible organisms.

Factors affecting ECHO-9 Virus Recovery from Cerebrospinal Fluid.

The clinical laboratory findings in a group of 104 patients with aseptic meningitis associated with ECHO-9 infection are presented and analyzed in an attempt to delineate factors affecting the isolation of virus from the CSF.Statistical analysis failed to adduce significant relationships between the sex of the patients, the peripheral white blood cell counts, the CSF cell counts and differentials, or the CSF protein levels and the ability to recover ECHO-9 from CSF samples. Though these findings cannot implicate interferon or antibody as factors mediating recovery from viral central nervous system disease, direct measurement of both would be necessary for definitive conclusions. However, it seems unlikely that cerebrospinal fluid interferon levels have any direct relationship to the degree of cerebrospinal fluid pleocytosis.Factores Afficiente le Recovrage de Virus ECHO-9 ab le Liquido Cephalo-RhachideeEs presentate le constatationes de laboratorio clinic in un gruppo de 104 patientes con meningitis aseptic, associate con infection per virus ECHO-9. Le datos es analysate con le objectivo de delinear factores afficiente le isolation de virus ab le liquido cephalo-rhachidee.Le analyse statistic produceva nulle significative relationes del possibilitate de-isolar virus ECHO-9 ab specimens de liquido cephalo-rhachidee con le sexo del patientes, con le numeration leucocytic in sanguine peripheric, con le numerationes total e differential de cellulas in le liquido cephalo-rhachidee, o con le nivellos de proteina in le liquido cephalo-rhachidee. Ben que iste constatationes non suffice a provar que interferon o anticorpore es factores que age como mediatores in le restablimento ab morbo de virus del systema nervose central, directe mesurationes de ambes es necessari pro arrivar a definitive conclusiones. Tamen, il pare pauco probabile que le nivellos de interferon in le liquido cephalo-rhachidee es directemente relationate con le grado de pleocytosis del liquido cephalo-rhachidee.