During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET) is recommended, because it is useful not only in the functional evaluation of the cerebral tissue after the injury, but also in assessing the dynamics of pathologic changes.

The diagnosis of infectious mononucleosis is usually based on the clinical signs and symptoms, characteristic changes in the peripheral blood picture and the results of specific and non-specific serologic tests. However, despite of these precise diagnostic criteria this disease is often misdiagnosed, misunderstood and therefore treated in a wrong way. Therefore, because of our long lasting clinical experience based on a very large number of cases, we have decided to present the results of our studies on the clinical features of this interesting disease as well as some laboratory findings (serum bilirubin level and AspAt, AlAt, AP and GGTP activity). The analysis of clinical and biochemical markers comprised 500 patients (236 males and 264 females) aged 15-35, in whom mononucleosis had been diagnosed according to the commonly approved criteria. The clinical signs and symptoms appearing during the first week of the disease, the results of the laboratory findings and the therapy are described in detail. It has been stressed, that the diagnosis of mononucleosis should be considered mainly in young patients with fever persistent for over one week accompanied by inflammatory changes in the throat and enlargement of the lymph nodes, liver and spleen and other pathologic signs and symptoms. Blood picture and the results of non-specific and specific serologic tests are helpful in the final diagnosis of this interesting disease.

Persistent lymphopenia of various intensity has been noted in 45% of persons who had a history of infectIous mononucleosis. The group consisted od 500 patients, (236 males and 264 females). In all of them the diagnosis of mononucleosis had been based on the characteristic clinical signs and symptoms and changes in the blood picture and confirmed by the non-specific and/or specific serologic tests. In 33 persons (10 males and 18 females) the total number of lymphocytes varied from 884 to 992 per 1 cmm, the distribution being as follows: B lymphocytes--146 to 198, CD4--482 to 645 and CD8--245 to 364 per 1 cmm. 18 persons (18 males and 10 females) were given thymosine (TFX) subcutaneously for 30 days in the dose of 0.02 g daily, the remaining 15 (7 males and 8 females) received 3.0 g of isoprinosine per day for the same period. The total lymphocytes count and that of B, CD4 and CD8 was performed before and after the treatment and then followed once a month until 180 days since the treatment had been started. The TFX therapy was repeated after 8-12 months since the end of the first course in 3 patients and that with isoprinosine in 4. The strategy and the examination pattern were the same as before, control examinations being performed every 6 months and final analysis was done after 5 years of follow-up. Among the 33 patients who received immunomodulating treatment, normalisation of the lymphocytes count appeared in 24 (64%). Among the 12 persons with less pronounced lymphopenia, who did not received any treatment, spontaneous normalisation appeared in 5 (40%). It may be therefore assumed, that in persons with the history of infectious mononucleosis with persistent marked lymphopenia, thymosine and isoprinosine may be used in the therapy as additional immunomodulators.

In 30 patients with mononucleosis-like syndrome (MLS) caused by cytomegalovirus (CMV), diagnosed on the basis of clinical symptoms, haematological & serological changes (after excluding Epstein-Barr virus, HAV, HBV and HCV infections), the following measurements were done weekly during consecutive two months': bilirubin concentration, aspartate & alanine aminotransferases (AST & ALT), alkaline phosphatase (ALP), beta-glucuronidase (B-GR), and gamma-glutamyltranspeptidase (GGTP) activity. Increase in bilirubin concentration was found in 6% of patients, increase of AST and ALT activity--in 70%, GGTP--in 50%, ALP--in 25%, and of B-GR--in 16% of the subjects. The highest bilirubin concentration, and high levels of AST, ALT, and B-GR were noted in the 2nd week of infection, whereas the peak activity of ALP and GGTP was found in the 3rd week of the disease. In all patients normalization of bilirubin concentration was earliest (5th week of infection); followed by decrease of AST, ALT, B-GR, and ALP activity (7th week), and subsequently--that of GGTP (8th week of the disease). The results of the investigations have shown that in the course of MLS the changes of hepatic activity are limited and transient; they return to normal synchronously with the withdrawal of clinical symptoms (4th-6th week of the disease), without permanent measurable consequences. In patients with MLS and increase AST & ALT activity (400-600 iu) as well as slight increased of bilirubin concentrations hepatitis C,A and B should be excluded. In has not been established so far whether the changes of hepatic function during MLS are the consequence of direct infection by CMV, reactivation of the primary occult infection (asymptomatic), or re-infection by a different serotype.

Basing on the own experience, the authors discuss causative treatment of sepsis, mainly of unknown etiology. Emphasis is on the depression of immunological system in the acute phase of the disease. Therefore, a combined treatment with 2, often 3 or even 4 bacterial antibiotics is recommended, together with passive immunotherapy, and in certain cases surgical removal of the infection foci.

Etiopathogenetic, diagnostic, and clinical problems seen in the adult patients with sepsis have been discussed. An emphasis is on the diagnostic problems in an early stage of infection as well as bacteriological findings. The authors stress that sepsis usually develops in patients with depressed immunological system.

CRP level was determined in the cerebrospinal fluid in 40 cases of bacterial meningitis. Similar determination in serum was done in 32 of these patients. Aetiological verification was possible in 90% of cases. Meningitis caused by Str. pneumonia and Neisseria meningitides prevailed (52.5% and 27.5% respectively). The control group comprised 20 subjects. For CRP demonstration immunochemical and turbidimetric methods were used. CRP in CSF was raised in 62.5% of the study cases while in the serum it was raised in all of them. CRP detection in serum in acute phase of central nervous system infection is diagnostically important since CRP increase suggests a purulent process.

The authors, basing on the own experience in the treatment of 578 patients with purulent meningitis and encephalitis, discuss etiologic and clinical problems as an early diagnosis of the cause decides on the proper therapy and often on the patient's fate. The authors are convinced that the result of general CSF examination is a crucial diagnostic criterion in meningitis and encephalitis but does not permit identification of the disease causes. Problems with etiological verification is discussed. The authors have found that the infection with N. meningitidis and S. pneumoniae remains the most frequent cause of the disease in adults. However, the cause of the disease cannot be determined in over 50% of patients, and etiological verification of infections caused by H. influenzae and anaerobic organisms is quite unsatisfactory. The authors stress that over 20% of patients had skull injury and meningitis most frequently resulted from the infection with S. pneumoniae in these patients. It is suggested that purulent meningitis and encephalitis as a rule is endogenous disease produced by the activation of endogenous source of the infection.

The authors discuss problems connected with diagnosis, management and treatment of bacterial meningitis among patients with the sepsis syndrome. Considering secondary organ changes bacterial meningitis belongs to the severest one and as a life-threathing sequel of sepsis demands immediate use of proper casual treatment. The authors show the therapeutic difficulties in this group of patients particularly when the etiological organism is unknown. They discuss this problems and present their own schemes of tretment. They indicate the value of passive immunotherapy and surgical removal of the primary source of infection. They emphasize final result depends on secondary organ changes, age, immunity of patient and the kind of etiological agent.

The authors present own methods and results of the treatment of 578 patients with suppurative meningitis and encephalitis. Etiologically most frequent infections due to N. meningitidis, S. pneumoniae, and H. influenzae were treated with penicillin and ampicillin; the authors recommend to replace the latter antibiotic with cefotaxime. If meningitis and encephalitis were due to aerobic gram-negative bacilli, a possibility of the simultaneous infection with anaerobic flora was considered, and the drugs active against both types of the organisms were administered. The same was the treatment in case of etiologically confirmed staphylococcal infection. In case of unknown etiology of meningitis and encephalitis therapy was based on clinical data, and laboratory findings.

Diagnostic, clinical and therapeutical problems of tuberculous meningitis and encephalitis have been discussed on a basis of clinical observation of 67 patients. In the early phase of disease the diagnosis is based on clinical parameters and results of cerebrospinal fluid examinations. Authors suggest a shortage of time treatment under 12 months.

The therapeutic effect of Bioglobulin was studied in some diseases of viral or bacterial etiology. It was found favorable as it seemed to lessen the clinical and the shorten the acute as well as the hospitalisation periods. Because in the very serious and serious diseases of viral or bacterial etiology the antibodies deficiency, absolute or relative, total or selective is common, Bioglobulin may be a valuable agent in the comprehensive treatment.

The therapeutic effect of isoprinosine and acyclovir have been studied in 352 and 284 patients with chicken-pox and herpes zoster respectively. The patients were divided into 4 groups: the first one was given palliative treatment only, the second--both palliative and isoprinosine ones, the third--palliative and acyclovir treatment, and the fourth group was given all these. The best therapeutic effect was achieved when acyclovir and isoprinosine was applied jointly, the one of acyclovir alone was less pronounced and that of isoprinosine only was the smallest. According to the authors acyclovir should be the treatment of choice in the very severe and severe cases of chicken-pox and herpes zoster; in the early stage of disease it should be supplemented with isoprinosine and passive immunotherapy.

The detailed clinical, hematological, and biochemical analysis performed in 332 patients in whom infectious mononucleosis had been diagnosed or suspected revealed the mononucleosis-like syndrome due to Cytomegalovirus infection in 4.5%. This diagnosis was confirmed by the presence of specific antibodies in the ELISA methods (most frequent titres 1:1600 and 1:3200) and or by the CFT (mostly 1:64 and 1:128). The diagnosis of infectious mononucleosis was confirmed in the Paul-Bunnell-Davidsohn test in the titre was greater than or equal to 1:56. Attention is drawn to the differences regarding the clinical signs as well as the clinical and biochemical parameters between the mononucleosis-like syndrome and the infectious mononucleosis. The clinical diagnosis of this syndrome is difficult however possible, if kept, in mind and if all the parameters are properly analysed. This diagnosis has to be always confirmed by serologic test.

The authors discuss problems connected with the clinical, aetiological diagnosis, methods and results of treatment of purulent meningoencephalitis in adults. The basis for the discussion were own experiences obtained during hospitalization of 578 patients in the period 1981-1990. As a results of this analysis the authors found that the organisms causing this disease most frequently were, as previously, Neisseria meningitidis and anaerobic Haemophilus influenzae were still highly unsatisfactory. Complete recovery was obtained in 73.3% of cases, 6.6% were discharged with various neurological sequelae, and 29.1% died. Cases of pneumococcal origin, frequent after cranial trauma, showed the most severe course, had the highest percent of psychoneurological complications and recurrences with the highest death rate.