Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis

Article Abstract:

Lyme borreliosis, also called Lyme disease, is transmitted by ticks infected with Borrelia burgdorferi. Tick bites are the usual mode of disease transmission. Lyme borreliosis may affect the skin, heart, nervous system, and joints. The disease is usually first noted by a skin lesion (a reddened area that may be flat or raised) at the site of the tick bite. When Lyme disease affects the nervous system it is called Lyme neuroborreliosis, and may lead to meningitis (inflammation of the membranes covering the brain and spinal cord), cranial neuritis (inflammation of the nerves in the head), and painful radiculoneuritis (inflammation of the root of the nerves exiting the spinal cord). Penicillin, one of the first drugs used to treat Lyme disease, is not effective in killing Borrelia burgdorferi. The effectiveness of two cephalosporin antibiotics was assessed in 33 patients with Lyme neuroborreliosis. Over a 10-day period, patients were treated with ceftriaxone (2 grams per day) or cefotaxime (6 grams per day). During the treatment period, neurological symptoms improved or disappeared in 12 of 17 patients treated with ceftriaxone and 14 of 16 patients treated with cefotaxime. Eight months later, symptoms had completely resolved in 17 of 27 patients. Ten patients continued to experience neurological symptoms and one of them remained infected with Borrelia burgdorferi. These results indicate that a 10-day treatment program with ceftriaxone or cefotaxime is effective in reducing clinical symptoms in patients with Lyme neuroborreliosis. However, some patients may required a longer treatment period to relieve all disease symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Disease transmission, Lyme disease, Nervous system, Cefotaxime, Ceftriaxone sodium

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Cerebrospinal fluid endotoxin levels in children with H. influenzae meningitis before and after administration of intravenous ceftriaxone

Article Abstract:

Bacterial meningitis due to Hemophilus influenzae remains a serious, frequently fatal disease. There has not been a significant reduction in case fatality rates, despite the availability of new and more potent antibiotics or chemotherapeutics. This adverse reaction may be due to the interaction between host cells and substances released when antibiotics destroy the bacteria. These products appear to stimulate pathophysiologic changes in the central nervous system (CNS), which can lead to irreversible injury to tissues in the system and produce long-term complications. Gram-negative organisms have high endotoxin (lipopolysaccharide, or LPS) concentrations in the outer membrane of the cell. Some antibiotic activity produces significant alterations in LPS levels in CNS fluids. A rise in LPS has been correlated with increased CNS injury. Ceftriaxone therapy resulted in a marked increase in free LPS in the cerebrospinal fluid of patients being treated for Hemophilus influenzae meningitis. This elevated LPS level correlated with increased CNS injury resulting in seizures, brain edema (swelling), and increased inflammation of the subarachnoid space (under the membrane surrounding the brain). The data reported here emphasize the need to evaluate therapy in which the antibacterial action causes the release of cellular products and components, which frequently are as toxic as the action of the intact bacterial cells. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Physiological aspects, Pediatric diseases, Antibacterial agents, Meningitis, Hemophilus influenzae, Haemophilus influenzae, Hemophilus meningitis

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Amplification of HIV-1 provirus from cerebrospinal fluid and its correlation with neurologic disease

Article Abstract:

Neurological disease often develops in patients infected with human immunodeficiency virus type 1 (HIV-1, the virus responsible for AIDS), but is frequently diagnosed by exclusion. Nucleated cells are frequently found in the cerebrospinal fluid (CSF) of HIV-1 patients without symptoms. The significance of these cells and the possible association with HIV-1-related disease are not clearly defined. The virus agent, if present in these cells, is there in relatively minute amounts. The polymerase chain reaction (PCR) is an enzymatic procedure that permits the amplification of specific DNA sequences occurring in particles of virus. Sequences of the genes encoding for precursors of the virus (gag and env provirus sequences) were detected by PCR and the results compared with other clinical and radiologic findings characteristic of neurological disease. A total of 31 CSF specimens from HIV-positive patients were examined. Provirus was detected in 21 patients, 20 of whom had neurologic disease of various etiologies. The precursors to the virus were not detected in six specimens from neurologically normal patients. No neurologic problems subsequently developed in four of these patients. The detection of HIV provirus by PCR in nucleated CSF cells of otherwise asymptomatic patients may provide the earliest indicators of neurologic involvement in HIV-positive patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, HIV infection, HIV infections, HIV (Viruses), HIV, Identification and classification, Polymerase chain reaction, Neurologic manifestations of general diseases, Neurologic manifestations

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