2017 Volume 33 Issue 4 Pages 510-514
Recent advances in the treatment of neurological infections are described based on reports published in 2014.
Cochrane Database Systemic Review reported the effect of adjuvant corticosteroid therapy in acute bacterial meningitis. Corticosteroids significantly reduced hearing loss and neurological sequelae, but did not reduce overall mortality. It recommended the use of adjunctive dexamethasone in patients with suspected or proven community–acquired bacterial meningitis, but only in high–income countries. The European research group reported causative pathogens, clinical characteristics, and outcome of adult community–acquired bacterial meningitis after the introduction of adjunctive dexamethasone treatment and nationwide implementation of paediatric conjugate vaccines. The incidence of adult bacterial meningitis has decreased substantially, which is partly explained by herd protection by paediatric conjugate vaccines. Adjunctive dexamethasone treatment was associated with substantially improved outcome.
Following standard treatment with intravenous acyclovir for PCR–confirmed herpes simplex encephalitis (HSE), Effect of an additional 3–month course of oral valacyclovir therapy was evaluated as measured by neuropsychological testing 12 months later. However, they did not show a benefit of long–term valacyclovir therapy. Recent reports showed that some patients with herpes simplex encephalitis (HSE) developed autoantibodies against NMDAR, in especially relapsing HSE. The clinical and immunologic features of patients with immune–mediated relapsing symptoms post–herpes simplex encephalitis were assessed. The teenage and adult patients developed severe psychiatric/behavioral symptoms or refractory status epilepticus, however, all younger children developed choreoathetosis. As immunotherapy can be highly effective, prompt diagnosis is important.
Microbiological confirmation cannot be obtained in approximately two–third patients with tuberculous meningitis. The epidemiological, clinical, cerebrospinal fluid, and imaging parameters among patients with tuberculous meningitis were assessed. Among 118 cases of tuberculous meningitis, there were 36% of definite, 50% of probable, and 14% of possible cases. Severe disability, cerebrospinal fluid cells >100 mm3, and basal exudates were significantly related to definite diagnosis of tuberculous meningitis. Microbiologically confirmed tuberculous meningitis is associated with poorer outcome.
Earlier antiretroviral therapy (ART) initiation in cryptococcal meningitis resulted in higher mortality compared with deferred ART initiation. The immune pathological study showed that early ART initiation in cryptococcal meningitis increased CSF cellular infiltrate, macrophage/microglial activation, and T helper 2 responses within the central nervous system. An increased mortality from early ART would be immunologically mediated.
The triple combination therapy interferon–α, valproic acid, and prednisolone in patients with HTLV–I–associated myelopathy/tropical spastic paraparesis (HAM/TSP) was evaluated. As the data showed that the triple therapy improved motor dysfunction of the lower extremities as well as reduced HTLV–I provirus levels in peripheral blood, it could be a potential as a new therapeutic tool for HAM/TSP patients.
