Olga Adriana Caliman-Sturdza

By Olga Adriana Caliman-Sturdza and Andrei Cucu

Hydrocephalus is a frequent complication of tuberculous meningitis. We present the incidence of hydrocephalus in patients diagnosed with tuberculosis of the nervous system, the therapeutic possibilities and the evolution of these patients. A consensus definition for tuberculous meningitis (TBM) stratified the cases as definite, probable and possible. In various studies, radiological investigations (CT, MRI) can be normal in the initial stages of the disease in approximately 30% of cases, but they do not exclude the possibility of a TBM. The most common radiological changes found in TBM are communicating hydrocephalus (up to 80% of cases), increased basal contrast (50%), cerebral tuberculomas (30%) and cerebral infarcts (10–40%). MRI has been shown to be more sensitive than a CT scan for diagnosed TBM. Communicating hydrocephalus is among the short-term complications of TBM (approximately 80% of cases), being more frequent than non-communicating ones. In these cases, the need to perform a ventriculo-peritoneal unit must be taken into account. Long-term complications are cognitive impairment, epilepsy, stroke, hydrocephalus, myelitis, damage to the hypothalamus or the pituitary gland manifested by obesity, growth disorders and diabetes insipidus. Sequels may occur frequently in TBM such as dementia, epilepsy, neurological deficits, behavioral disorders, blindness and deafness.

Part of the book: Frontiers in Hydrocephalus

By Olga Adriana Caliman-Sturdza

Infective endocarditis (EI) produced by enterococci ranks third among infectious endocarditis and is a severe infection with usually subacute onset, often complicated with valvular lesions, systemic emboli and immunological changes. EI caused by enterococcus is produced in 90% of cases by Enterococcus faecalis and much less often by Enterococcus faecium or other species. Most cases are acquired in the community, but enterococcal EI can also be nosocomial. Enterococcal endocarditis is more common in the elderly or may appear against the background of some associated conditions: colorectal cancer, liver cirrhosis, diabetes, immunosuppressive treatments. Transthoracic echocardiography combined with blood cultures is the basis of the diagnosis of infective endocarditis, but in difficult cases, transesophageal ultrasound and new imaging methods such as computer tomography, PET-CT or cardiac MRI can be the solution for establishing the diagnosis. Enterococci are very tolerant to bactericidal antibiotics and their eradication requires prolonged therapy (up to 6 weeks) with synergistic bactericidal combination of cell wall inhibitors with aminoglycosides, they can also be resistant to many antibiotics, including beta-lactams, aminoglycosides and vancomycin. E. faecium is often resistant to vancomycin and beta-lactams. Linezolid may be effective in the treatment of vancomycin-resistant enterococcal endocarditis, but also daptomycin, dalbavancin and oritavancin seem promising.

Part of the book: Enterococcus - Unveiling the Emergence of a Potent Pathogen [Working title]