s210 Bacterial, Fungal & viral Infections of the Nervous System

Patients: All patients, under 15 years old, with clinical and laboratorial diagnosis of TBM, were enrolled in this study.

Results: From January 1980 to December 1998, two hundred seventy-two patients, admitted at the HCMaia, had the discharge diagnosis of TBM. The patients were separated in two groups. Group 1: Fifty-six cases with confirmed TBM by the presence of acid fast bacilli (AFB) or positive culture in CSF. Group 2: Two hundred-sixteen cases with obscure chronic lymphocytes meningitis, a clinical picture of TBM, and response to antitubercular therapy. Table 1 shows the CSF and clinical characteristics of children with TBM:

Table 1

Characteristics Group 1 (N = 56) Group 2 (N = 216) p Global (N = 272)

Male 53.6% 60.6 0.34 59.2% Age (mean/SD) 2.16 (3.26) 3.23(4.36) 0.71 2.96(4&l) Fever 91.1% 66.6% 0.36 67.5% Vomit 66.1% 62.5% 0.62 63.2% Seizures 57.1% 37.5% 0.007 41.5% DCL 41.1% 32.9% 0.25 34.6% Nuchal rigidit 25.0% 41.2% 0.026 37.9% CSF cells (mean/SD) 305 (320) 317 (433) 0.17 311 (381) CSF glucose (mg %) 42.6 (27.3) 39.5 (23.4) 0.64 40.4 (24.9) CSF protein (mg %) 201 (147) 167 (149) 0.44 192 (149) Lethality 67.3% 36.0% <O.&l1 42.3%

Conclusion: In a previous study we demonstrated that TBM is endemic in the state of Bahia, mainly in children. It is clear that the vaccinal cover is insufficient in the Northeast of Brazil and the majority of children arrive to the reference hospital in advanced stages of disease, which is probably responsible for the higher lethality observed in this study.

4-04-02 CSF data in a infectious disease hospital from the Northeast of Brazil

Adrfana Cardoso, Rogerio Santos-Jesus, Luciana Hughes, Tania Maia, Marco Antonio Novaes, Luciana Nunes, Ricardo Peixoto, Murflo Souza, Amanda Almeida, Rita Lucena, lrenio Gomes, Ailton Melo. Neuroinfectology and Neuroepidemiobgy Division. Federal Univemity of Bahia, Salvador, Bahia, Btasil

Objective: To describe the records of CSF exams in a referral center for infectious disease in the Northeast of Brazil.

getting: Hospital Couto Maia (HCMaia), a large infectious disease hospital in Salvador, the Northeast of Brazil. The HCMaia treats almost all cases of community meningitis from the city and nearly 50% from the state’s countryside.

Design: diagnosis study. Main Outcome Measures: Routine HCMaia procedures in patients sus-

pected of infectious neurologic disease or Guillain Barre syndrome include immediate analysis of CSF in admission. All samples are analysed for glucose, protein and differential leukocyte count. Gram stain and culture are performed if acute bacterial meningitis (ABM) is suspected.

Results: From January 1989 to December 1998 8794 CSF samples were collected. 19.3% of the samples were excluded due to incomplete data or hemorrhage and 7799 samples were included in this study. From those that were included in the study 41% were normal. Culture was positive in 7.8% and gram stain was positive in 8.8% (from these 1.2% had less than four leukocytes). Table 1 shows the main identified bacteria in CSF samples:

Table 1

Bacteria Proportion l-t. influenzae 36.5% N. meningitidis 25.4% S. pneumoniae 19.9% S. aureus 5.6% E. coli 0.7% Others 9.9%

Conclusion: In previous studies, from our group, we demonstrated that ABM is responsible for 20.9% of lethality in our state. Although there is a large acceptance that prompt treatment for ABM is recommended, even in suspected cases, the correct diagnosis using CSF analysis should be sought. We believe that the low rate of specffic diagnosis and the time to reach the hospital are the main causes for the high lethality rate of ABM in some regions of Brazil.

I__I 4 04 03 Subacute sclerosing panencephalitis: Clinical evolution of a case

M.J. de Oliveira, M.J. Aguiar, L.T.P. Gomes, A.W.S. de Souza, S.M.B. Jeronimo. Department of Infectious Diseases (Federal University of Rio Grande do Norte), Giselda 7iigueiro Hospital, Natal-RN, Brazil

Objective: Presentation of case of a rare infectious disease of the central nervous system, simulating a degenerative one.

Report of the Case: A 12-year-old boy that had bad measles 9 years ago presented behaviour modifications and falls in September 1991. Approximately one month after this he had disturbances of orientation, of speech, of sensop- erception and of mood; he had also myoclonic and generalized tonic-clonic fits. In January 1992 the behaviour abnormalities persisted and there were tremors mid extremely frequent myoclonic-atonic fit. He got even worse. He became unable to walk and presented difficulties in verbal expression, simple partial fits, generalized muscular stiffness and crisis of hyperthermia. He was unable to control his sphincters. In September 1993 he was decorticated. He died in November of that year. There was periodic activity in his electroen- cephalogram. His cerebrospinal fluid showed high titers of antibodies against measles.

Conclusion: The authors report the clinical evolution of the present case and commit on the Van Bogaert’s encephalitis.

4-04-04 Intra-hospital lethality of acute bacterial meningitis in adult patients

lrenio Gomes, Rita Lucena, Ailton Melo. Neuroepidemiobgy and Neuroinfectious Division/Federal University of Bahia, Brasil

Objective: To describe the intra-hospital lethality of adult patients, with acute bacterial meningitis, admitted at Hospital Couto Maia (HCMaia) in Northeastern Brazil.

Study Design: Retrospective cohort to study prognosis. getting: Hospital Couto Maia, a referral public hospital for admission of

infectious disease of the State of Bahia, Northeast of Brazil. The HCMaia treats almost all cases of community meningitis from the city and nearly 50% from the state countryside.

Patients: All cases of acute bacterial meningitis, in 15-year-old individuals or older, were enrolled. All patients with open head trauma, neurosurgical history, relapsing meningitis or those which the CSF exam demonstrated a predominance of hematias were excluded.

Analysis: In order to build a sulvival table the nonparametric Kaplan-Meyer analysis was used. Survival curves were made considering whether the agent had been identified or not and also for N. meningitidis and S. pneumoniae.

Results: From January 1990 to December 1992, 178 adult patients with diagnosis of acute bacterial meningitis were admitted at HCMaia. There were 57% of males and the mean age was 32, 8 years (SD: 15.4). Etiologic agents were identified in 114 (84%) cases. N. meningitidis was the most frequent bacteria and it was responsible for 55.3% of cases. The second causative agent was S. pneumoniae (38.8%) and E. coli was responsible for four cases (3.5%). The overral lethality rate was 19.1%. The rate was higher among cases with identified agents (23.7%) than among those unindentified (11%); x2 = 4.31, p = 0.04.

Fig 1. Intra-hospital survival curves showing comparison between N. meningitidis and S. pneumoniae.

Fig 2. Comparison between identified and unidentified agents.

Conclusion: It is clear that lethality rate is more important in cases with S. pneumoniae. Difference between the agents occurs mainly on the first day after admission.

IZIl outcome 4-04-05 Length of amnesia in acute encephalitis predicts

L. Hokkanen, J. Launes. University of Helsinki, institute of Clinical Neuroscience, Finland

Objective: The length of post-traumatic amnesia is an indicator of severity and a predictor of outcome in brain trauma. Similar temporary amnesia is encoun- tered in acute encephalitides. We studied the prognostic value of Transient ENcephalitic Amnesia (TENA) in acute encephalitis.