Wednesday, November 9, 2005
Background: The differential diagnostic between Myelopathy/tropical spastic paraparesis (HAM/TSP) and progressive multiple sclerosis (MS) is still a challenge. Method: To differentiate patients with neurologic disease consistent with the clirdcal diagnosis of HTLV-I associated myelopathy/tropical spasic paraparesis (HAM/TSP) from patients with multiple slcerosis (MS) who are HTLV-I seroposirive, we compared the intrathecal synthesis of HTLV-I antibodies and HTLV-I proviral D N A loads in CSF and PBMC between 19 HAM/TSP patients, 22 HTLV-I positive non-HAM/TSP patients (seven with other neurological diseases, 11 asymptomatic carriers and four with multiple sclerosis (MS)-like manifestations). Results: The proviral load in CSF and PBMC was higher in HAM/TSP than in non-HAM/TSP patients. Furthermore, the HTLV-I proviral D N A load in CSF positively correlated with that of PBMC, however, with a tendency inversely correlated with the intrathecal synthesis of HTLV-I antibodies. The group of tropical spastic paraparesis with MS-like manifestations had the proviral load in CSF and PBMC comparable to HAM/TSP patients. These laboratory studied parameters remained stable during the follow-up. Conclusion: These data suggest that the high proviral load in PBMC attd/or in CSF represent a good marker of HAM/TSP and can differentiate HAM/TSP from HTLV-I infected non-HAM/TSP patients. 0807 Evaluation of viable mycobacterium polymerase chain reaction in csf of clinically suspected tuberculous meningitis Atam, V, Chandra, A , Chopra, V. 2f(-ing George Medical University Background: T.B.M is most dangerous form o f extra pulmonary tuberculosis. Facilifies to confirm are least available in many developing countries where the causes of meningitis are highly diverse conventional techniques such as direct AFB microscopy and culture have low sensitivity and PCR bio technique is a helpful tool for diagnosis of TBM. Method: 46 suspected cases of TBM were evaluated clinically and subjected to investigations like CSF examination, head CT scan, CSF assessment for NESTED Reverse transcriptase PCR (RT-PCR) along with 40 age sex matched control without symptoms of TBM. Results: 46 patients of TBM were divided into 3 group Group-I H I G H L Y PROBABLE TBM, Group-II PROBABLE TBM, GroupIII POSSIBLE TBM Results of CSF RT-PCR found to be positive in 30 patients out of 46. RT PCR positive in 14 cases of Group-I, 6 cases o f Group-II and 1 case of Group-III. Microscopy AFB was positive only in 3 cases of Group-I Sensitivity of RT-PCR (165.21%) Specificity of RT-PCR (97.5%) Positive Predictive value of RT-PCR (165.21%) Negative Predictive value o f RT-PCR(97.5 %) False Negative (134.787,';) False Positive (2.5%) 0808 Cenlral Nervous System IJsteriosis: Caudocranial Course of the Lesions ~ebnem Bl~akcl, All Ozeren, Kenan Bl~akcL Filiz Kibar, Figen Ozcan, Ne~e Salto~hi.
CNS mattifestations of the disease are described as leptomeningitis, rhombencephalitis or syringomyelia in the literature. We report a patient with C.NS listeriosis, showing a caudocranial course of lesions. Fifty-years old female admitted with dysphagia and weakness. She had headache, vertigo, nausea and vomiting a month ago, followed by diplopia and dysphagia. During hospitalization, subfebrile fever, confusion and lethargy, lower cralfial nerve signs, quadriparesis and bilateral cerebellar signs were detected. Cerebral M R imaging at the adnfittance showed a plaque-like lesion in the bulbomedullary junction
extending cranially into the posterior pons and mesencephalon. Focal enhancement was seen in the bulbar lesion with contrast. Serum and cerebrospinal fluid culture at the end o f the week of hospitalization revealed listeria monocytogenes. Her clirdcal status worsened and coma developed. Serum and cerebrospinal fluid culture revealed llsteria monocytogenes. Aznphiciline and gentamycine were administered for listeriosis. Control spinal and cerebral M R showed progression of previous lesions into both basal ganglia and thalami. A n expanding diffuse lesion in the cervical cord was also detected. At the end of the third week of antibiotherapy, control M R was performed. Brainstem lesions were almost completely regressed, whereas multiple microabscesses in both basal ganglia and centrum semiovale appeared. Dural thickening with contrast enhancement suggesting meningitis were also detected. However, due to new lesions on MR, antiobiotic regimen was changed. The patient is still hospitalized in deep and prolonged coma status. This case emphasizes the importance of recognition of listeria's rare manifestation as rhombencephalomyelitis and cerebral rnicroabscesses. 0809 Acute Bacterial meningitis In H I V Inlected Patients In Southern Brazil
de Almeida, S 1"2, Zavala, j1, Gabardo, B 3, Ribeiro, C 3, Rossoni, A 3, Araujo, j 3 Werueck, L 1. 1Neurology Unit- Hospital de ClinicasFederal University of Parana, Curitiba, Brazil," 2HIV Neurobehavioral Research Center- UCSD, San Diego, USA; 3Municipal Public Health Department, Curitiba, Brazil Background: Acute conmmnitarian bacterial meningitis (ABM) and HIV are prevalent infectious diseases and co-infection can occur. We evaluated the frequency of ABM in patients with AIDS. Method: Retrospective revision of Municipal Public Health Department reports in Cktritiba, Brazil from 1996 to 2002 to identify cases with ABM and AIDS. Results: 1,732 cases of ABM were identified (1998 ABM with a non specified etiologic agent; 474 N. meningitides; 169 S. pneumoniae; 91 H. [email protected]
Thirty-two parientsmet criteria for ABM and AID S. ABM represents 0.84% of the cases with AIDS and 1.85% of total cases of diagnosed ABM. In 9 of 32 co-infected cases (28%), bacteria were identified in CSF (Gram smear and/or culture); S. pneumoniae (in 4), N. meningitides (n -- 1), E. coli (n -- 1) and Sabnonella sp (in - 1). In other two cases, only by CSF bacterioscopy (Gram negative bacillus). In the 32 co-infected patients, 75% were men. Mean (± SD) age was 39 years (±12.5 years). CD4 + counts (112/34 patients) (mean ± SD) was 124 ± 71 cells/ram~ (from 40 to 305 cells/mm~). Mortality rate of all cases with isolated bacteria was 56% higher than overall meningitis mortality rate. All cases of pnemnococal meningitis died. White blood cells count was higher (p 0.12), percentage of neutroptfils was higher (p 0.008) and glucose was lower (p 0.04) in HIV-patients. Conclusion: CSF characteristics may be different in HIV infected patients. H I V + individuals are more likely to develop ABM from less common bacteria. High mortality rate among pneumococal meningitis patients makes pnemnococal vaccination important. 0810 Clinical, biochemical & radiological correlation in patients of Tubercular Meningitis: A study of 50 cases Dubey, TN, Sharma, VK, Tirkey, P, Gopal, A, Dengra, A, Hiranandani, H, Satija, V, Gopal, R, Rajarajan, T. Hamidia Hospital,
Gandhi Medical College, Bhopal, India Background: To study C.T. findings in patients of tubercular meningitis diagnosed on basis of history, clinical evaluation, biochemical nivestigafional procedures with clinicoradiological correlation and identification and localization of intracranJal pathologies. Methods: 50 cases with history and clinical features suggestive of tubercular meningitis, o f various age groups and both sexes,