In developing countries tuberculous meningitis is a difficult infection to differentiate from other central nervous system (CNS) infections. This paper presents the history, physical findings, laboratory data, and clinical course of 100 patients who were admitted to a special ward and had CSF cultures positive for Mycobacterium tuberculosis. Fifty-four patients were comatose when admitted and 76 had meningeal signs. Mean admission CSF values were WBC 531, glucose 23 mg/dl, and protein 166 mg/dl. Only two CSF AFB smears were positive. Sixty-one percent of the chest X-rays taken were consistent with pulmonary tuberculous and 39% were normal. Twenty-four patients died within the first week after admission, before the clinical diagnosis was made and anti-tuberculous therapy could be started. Fifty-three of 76 patients given antituberculous therapy died. Neurologic sequelae developed in 48% of the survivors. The high mortality and morbidity rates in this patient-group were due to the severity of illness on admission and the predominance of children (54%).

Twenty-seven patients with tuberculous meningitis (TBM) were treated with ethambutol, isonicotinic acid hydrazide, streptomycin and dexamethasone and 28 were treated with triple anti-tuberculous drugs only. Only two of the patients to whom steroids were given developed ocular complications as compared to seven of those not receiving dexamethasone. High dose dexamethasone apparently prevents optic atrophy in TBM. Controlled double-blind studies with and without dexamethasone are needed to confirm this postulation.

In a study of obscure fevers in Cairo, Egypt, 24 cases of hepatic amoebiasis were diagnosed during a 3-year period from 1977-1980. The counterimmunoelectrophoresis amoebic serologic test was positive in 20 of the 24 patients and was very useful in confirming the diagnosis. The four patients in whom the test was negative had been ill for between 1 and 5 months and had been treated with antibiotics and amoebicidal drugs. Technetium-99 liver scanning localized the site and extent of the abscess and was essential for planning therapy. Treatment with metronidazole and tetracycline resulted in rapid clinical improvement in all except one patient. However, improvement did not indicate cure as our results show: nine patients required needle aspiration of the liver abscess, and seven others had to be referred to surgery for abscess drainage. Large abscesses over 10 cm in diameter should be aspirated to avoid relapse or rupture.

28 patients with bacterial meningitis received ampicillin by the intramuscular (IM) route and 16 patients by the intravenous (IV) route. The mean cerebrospinal fluid (CSF) ampicillin levels were similar in the two groups 1 h after a dose given on the first or second day of treatment, but they were higher in the IM group on both days 4 h after a dose. CSF/serum ratios were similar in both groups but considerably higher at 4 h than at 1 h.

Hearing affection as a sequel of meningococcal meningitis and its relation to age, sex, severity and duration of disease was studied in Cairo, Egypt during the period December 1966--December 1973. The total incidence of impaired hearing in the 775 cases was 5.8%. This incidence was higher in the younger age groups, females, severe cases of meningitis and in patients who received specific therapy shortly after the onset of signs and symptoms of the disease. The aetiology of hearing impairment in meningitis was reviewed.

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 μg/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 μg/ml at 1.5 h and from 2.6 to 27.0 μg/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.

Seventy-one patients diagnosed to have tuberculous meningitis were treated with isoniazid, streptomycin plus either rifampicin (36 patients or ethambutol (35 patients). Results of therapy were identical in both treatment-groups (approximately 50 per cent mortality). Rifampicin appears to be as effective as ethambutol in the treatment of this infection.

96 patients with meningitis due to Neisseria meningitidis and Diplococcus pneumoniae were treated with epicillin or ampicillin according to a predesigned randomization chart. Results indicate that epicillin and ampicillin are effective single drugs in the treatment of meningococcal and pneumococcal meningitis. No adverse reactions were noted with either drug and they were comparable in their efficacy.

This is a prospective treatment study of 86 patients with tuberculous meningitis admitted to the Abbassia Fever Hospital Cairo, Egypt. The causative organism was cultured from the cerebro spinal fluidin 47 patients, was identified by Zeihl Nelson stain in five and in the remaining 34 patients the diagnosis was based on the clinical course and changes in the CSF chemistry and cell count. The data indicate that ethambutol can be used as a companion drug to INH and streptomycin in the treatment of the disease and that the mortality is directly dependent on the state of consciousness upon initiation of therapy.

: The report is a prospective treatment study of 187 patients with purulent meningitis admitted to the Abbassia Fever Hospital, Cairo, U.A.R. The causative organism was grown from the spinal fluid in 66% of the cases. Of the culture positive cases, 49% were due to Neisseria meningitidis, 29% to Diplococcus pneumoniae, 12% to Haemophilus influenzae and 10% to miscellaneous organisms. The data indicate that these are the predominant organisms causing meningitis in the U.A.R. and that ampicillin is an effective single drug in the treatment of bacterial meningitis.

Journal Article MEASLES ENCEPHALITIS WITHOUT EXANTHEM Get access M. W. YASSIN, M. W. YASSIN †Abbassia Fever HospitalCairo, U.A.R. Search for other works by this author on: Oxford Academic PubMed Google Scholar N. I. GIRGIS, N. I. GIRGIS ‡United States Naval Medical Research Unit No. 3Cairo, U.A.R. Search for other works by this author on: Oxford Academic PubMed Google Scholar K. E. ABDEL WAHAB, K. E. ABDEL WAHAB **Virus Research Center and Guest investigator at U.S. Naval Medical Research Unit No. 3Agouza, U.A.R. and Cairo, U.A.R. Search for other works by this author on: Oxford Academic PubMed Google Scholar N. A. EL MASRY, N. A. EL MASRY ‡United States Naval Medical Research Unit No. 3Cairo, U.A.R. Search for other works by this author on: Oxford Academic PubMed Google Scholar A. ABU EL ELA A. ABU EL ELA †Abbassia Fever HospitalCairo, U.A.R. Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Tropical Pediatrics, Volume 16, Issue 4, December 1970, Pages 179–183, https://doi.org/10.1093/tropej/16.4.179 Published: 01 December 1970