RESUMO
Scientific knowledge of meningococcal infection has increased greatly since the epidemic nature of the illness was first described by Vieusseux at the dawn of the nineteenth century. In fact, revolutionary advances have been made in public-health measures, antimicrobial therapy, diagnostic procedures, anti-inflammatory drugs and supportive care facilities. Based on the knowledge accumulated to date, it is generally accepted that the pathogenesis of meningococcal infection involves multiple links that interconnect in a complex web of phenomena from Neisseria meningitidis attachment to meningococcal sepsis or meningitis. In fact, a myriad of strongly interacting inflammatory molecules and cells have been implicated in neisserial infection, illustrating the complexity of meningococcal pathogenesis. In addition, many of these signallers are critically involved in outcomes in the human host. Deciphering the pathogenesis of meningococcal infection could expand our knowledge and provide important clues to the host-pathogen interaction, as well as leading to the development of new therapeutic tools. Herein, we review the history of the discovery and characterization of meningococcal disease, epidemiological features of the disease with an emphasis on recent developments in Brazil, the cellular and molecular basis of disease, and discuss diagnosis and therapy.
Assuntos
Infecções Meningocócicas/etiologia , Citocinas/fisiologia , Humanos , Lipopolissacarídeos/toxicidade , Infecções Meningocócicas/diagnóstico , Infecções Meningocócicas/terapia , Receptores Toll-Like/fisiologiaRESUMO
In patients with meningococcal infection, devastating presentations, such as purpura fulminans, which can progress to extensive tissue necrosis of the limbs and digits, have a significant social impact. The case presented herein illustrates such a phenomenon in a patient who developed bilateral necrosis of the lower extremities as a result of infection with Neisseria meningitis. We emphasize that severe myalgia was the first clinical manifestation of meningococcal purpura fulminans in our case. However, myalgia has typically been overlooked and undervalued as an early clinical feature of meningococcal sepsis. Early recognition and prompt initial antibiotic therapy continue to be the cornerstones of the successful management of this dramatic disease, reducing morbidity and mortality.
Assuntos
Vasculite por IgA/microbiologia , Meningite Meningocócica/patologia , Neisseria meningitidis/isolamento & purificação , Adulto , Humanos , Vasculite por IgA/imunologia , Vasculite por IgA/patologia , Masculino , Meningite Meningocócica/sangue , Meningite Meningocócica/líquido cefalorraquidiano , Neisseria meningitidis/genética , Reação em Cadeia da Polimerase/métodosRESUMO
We report the first case of Neisseria meningitidis-induced septic peritonitis diagnosed by PCR assay of peritoneal fluid. Concentrations of interleukin-6 were notably higher in the peritoneal fluid than in the blood. PCR diagnosis of septic meningococcal peritonitis and the pathogenesis of the disease are discussed.
Assuntos
Interleucina-6/metabolismo , Neisseria meningitidis/imunologia , Peritonite/imunologia , Criança , Feminino , Humanos , Interleucina-6/sangue , Infecções Meningocócicas/imunologia , Infecções Meningocócicas/metabolismo , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Peritonite/metabolismo , Peritonite/microbiologia , Reação em Cadeia da PolimeraseRESUMO
An unusual case of leptospirosis is described in a 19-month-old male child presenting with meningitis and acute renal failure without jaundice. Some aspects concerning the pathogenesis and treatment of this potentially life-threatening disease are also discussed. Leptospirosis was diagnosed on the basis of history and serological tests.
Assuntos
Injúria Renal Aguda/etiologia , Meningites Bacterianas/etiologia , Doença de Weil/complicações , Injúria Renal Aguda/diagnóstico , Anticorpos Antibacterianos/sangue , Humanos , Lactente , Leptospira interrogans serovar icterohaemorrhagiae/imunologia , Masculino , Meningites Bacterianas/diagnóstico , Doença de Weil/diagnóstico , Doença de Weil/imunologiaRESUMO
We describe an unusual case of leptospirosis in a 54-year-old man presenting peripheral nerve palsy. The diagnosis of leptospirosis was confirmed by ELISA IgM and the microscopic agglutination test. Electrophysiological studies showed that no response could be obtained from the right fibular nerve. At 7 months after the initiation of treatment, additional electrophysiological studies and a neurological examination showed, respectively, a chronic axonal lesion of right fibular nerve with signs of re-innervation and a nearly complete clinical recovery. We feel that this case may serve to remind clinicians that peripheral nerve palsy is a potential clinical feature of leptospirosis.
Assuntos
Leptospirose/complicações , Neuropatias Fibulares/etiologia , Eletromiografia , Humanos , Perna (Membro) , Leptospirose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/fisiopatologiaRESUMO
We here report the case of a previously healthy 20-y-old male with disseminated meningococcal disease and purulent pericarditis. Polymerase chain reaction was used to identify Neisseria meningitidis serogroup C as the causative agent in the pericardial fluid.
Assuntos
Infecções Meningocócicas/complicações , Neisseria meningitidis Sorogrupo C/patogenicidade , Pericardite/etiologia , Adulto , Ceftriaxona/uso terapêutico , Humanos , Masculino , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Pericardiocentese , Pericardite/fisiopatologia , Pericardite/terapia , Reação em Cadeia da PolimeraseRESUMO
The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.