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 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.

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 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.