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A case of sensorineural hearing loss, secondary to syphilis?
Al3
FIS 99 Abstracts POSTER PRESENTATIONS P2
Pl
MENINGOCOCCAL DISEASE; AN AUDIT OF DIAGNOSIS. D.Modha , Clinical Microbiology and PHL, Leicester Royal Infirmary , Leicester, UK.
A CASE OF SENSORI%- HEARING LOSS, SECONDARY TO SYPHILIS ? N.Lazaro and BP Goomey, Manchester Centre For Sexual Health, Manchester Royal Infirmary
With the introduction of the new conjugate vaccine against group C N.meningifidis there is a need to have laboratory confirmation of meningococcal disease and to determine the causative clones. Of 101 cases of clinically suspected meningococcal disease in Leicestershire in 1998 onIy 43 cases were confirmed microbiologically. An audit was carried out to determine if these patients were being adequately investigated . Findings 93% of patients had blood cultures,82% EDTA blood for PCR, 60% throat swabs, 58% serum (for antigen and serology), 52% CSFs and 20% skin scrape from haemorrhagic lesions. Only 4% of patients had convalescent serology to attempt a retrospective diagnosis. On 8 occasions isolates were obtained when PCR was negative and on 11 occasions non-culture techniques were positive when culture was negative. Conclusion This audit showed that patients with clinically suspected meningococcal disease continue to be underinvestigated and that a full set of specimens is needed to obtain the maximum yield of laboratory diagnosed cases.
We report the case of a 69 year old white homosexual male,who presented with an unrelated problem. Routine Syphilis Serology revealed a positive Treponemal ELISA antibody test,with a TPHA of 1:2560 and an RPR of 1: 1 .There had been no history of congenital or acquired syphilis or previous treatmentHe admitted to several male sexual contacts in Morocco in the late 60s. It was revealed that he had a 2 year history of increasing hearing loss in his left ear(hearing in the right ear remained normal)and had been investigated by the ENT surgeons.However the cause could not be determined. In view of the history and the positive syphilis sexology an audiogram was performed both before and following treatment of his Latent Syphilis.The audiograms (enclosed)demonstrate a marked low frequency hearing loss of the lefi ear compared with the right. Following adequate therapy with daily intramuscular injections of Procaine Penicillin,a repeat audiogram showed a remarkable improvement in hearing loss five months post treatment. Clinically the patient noticed a significant improvement of his hearing one week following treatment,and continues to improve. P4
P3 BILATERAL CEREBRAL ABSCESSES AND CRANIAL. NERVE PALSIES IN MENINGOCOCCAL M E N I N G I T I S . CThomas’, N . Strickland2 a n d J. Friedland’, Departments of Infectious Diseases’ and Radiolo&, Hammersmith Hospital, London. Hisfory: A 17 year old woman presented with 1 week
history of meningism, complete right, and partial left, 3”nerve palsies. CRP was 104mg/l. A CT scan of her brain was normal, and CSF showed a predominant neutrophilia of 635 WBC/pl. No organisms were seen or grown on culture. In view of her unusual neurology, an MRl scan was performed, and surprisingly multiple enhancing white matter lesions were found, which represented abscesses. An extensive serological and molecular search for a pathogen was negative.
She was
treated with parenteral and then oral broad-spectrum antibiotics. Early follow up MRIs demonstrated little improvement but eventually complete resolution of abscesses. Neisseria meningitidis (NM) was then diagnosed of acute and convalescent serology, 7??e lessons:(i) CT and MRI are not interchangable - to be discussed in the context of the new BIS guidelines (ii) Cerebral nerve palsies due to vasculitis and’ (iii) abscesses are rare presentations of NM which require
extended antibiotic therapy. Key Images: CT on admission, 3 MRl scans
SUEJCLINICAL DEFICITS IN AUDITORY PERFORMANCE FOLLOWING RECOVERY FROM BACTERIAL MENINGITIS
M.Mulheran’, M. Johnstone’, RG Finch’, MJ Wiselk$.
MRC Toxicology Unit, Universi@ of Leicester’, Depb of Infection 4 and Eti8 Leicester Royal Infirmary and Dept of Infection, City Hospital, Nottingham3.
Introduction The risk of hearing loss after proven bacterial meningitis, is well recognised and is conventionally measured using standard pure tone audiometry (PTA), The aim of this study was to employ more sophisticated audiological measurement techniques to identify evidence of any subclinical deficits in auditory performance in this patient group. Methods Patients (n=17) who had recovered from proven bacterial meningitis were recruited from two clinical centres. All patients had initial audiometrical screening by tympanometry and questionnaire in order to exclude any other likely cause of hearing deficit. Patients then performed a battery of tests designed to measure different aspects of auditory function which included: standard PTA (from 025 ld-lz to 8 kHz); High Frequency PTA (HFPTA from 10 kHz to 16 kHz); frequency resolution at 2, 4 and 8kHz; and distortion product otoacoustic emissions (DPOAEs). The results were then compared with similar aged controls (n=44). Results and Conclusions The results from this preliminary study showed that there were significant subclinical deficits in the HFPTA and in measures of frequency resolution. There was also evidence of deficit in the DPOAEs. These effects have implications for our understanding of the development of hearing loss after bacterial meningitis and may be an explanation for the attention and concentration deficits often reported after bacterial meningitis.
FIS 99 Abstracts POSTER PRESENTATIONS P2
Pl
MENINGOCOCCAL DISEASE; AN AUDIT OF DIAGNOSIS. D.Modha , Clinical Microbiology and PHL, Leicester Royal Infirmary , Leicester, UK.
A CASE OF SENSORI%- HEARING LOSS, SECONDARY TO SYPHILIS ? N.Lazaro and BP Goomey, Manchester Centre For Sexual Health, Manchester Royal Infirmary
With the introduction of the new conjugate vaccine against group C N.meningifidis there is a need to have laboratory confirmation of meningococcal disease and to determine the causative clones. Of 101 cases of clinically suspected meningococcal disease in Leicestershire in 1998 onIy 43 cases were confirmed microbiologically. An audit was carried out to determine if these patients were being adequately investigated . Findings 93% of patients had blood cultures,82% EDTA blood for PCR, 60% throat swabs, 58% serum (for antigen and serology), 52% CSFs and 20% skin scrape from haemorrhagic lesions. Only 4% of patients had convalescent serology to attempt a retrospective diagnosis. On 8 occasions isolates were obtained when PCR was negative and on 11 occasions non-culture techniques were positive when culture was negative. Conclusion This audit showed that patients with clinically suspected meningococcal disease continue to be underinvestigated and that a full set of specimens is needed to obtain the maximum yield of laboratory diagnosed cases.
We report the case of a 69 year old white homosexual male,who presented with an unrelated problem. Routine Syphilis Serology revealed a positive Treponemal ELISA antibody test,with a TPHA of 1:2560 and an RPR of 1: 1 .There had been no history of congenital or acquired syphilis or previous treatmentHe admitted to several male sexual contacts in Morocco in the late 60s. It was revealed that he had a 2 year history of increasing hearing loss in his left ear(hearing in the right ear remained normal)and had been investigated by the ENT surgeons.However the cause could not be determined. In view of the history and the positive syphilis sexology an audiogram was performed both before and following treatment of his Latent Syphilis.The audiograms (enclosed)demonstrate a marked low frequency hearing loss of the lefi ear compared with the right. Following adequate therapy with daily intramuscular injections of Procaine Penicillin,a repeat audiogram showed a remarkable improvement in hearing loss five months post treatment. Clinically the patient noticed a significant improvement of his hearing one week following treatment,and continues to improve. P4
P3 BILATERAL CEREBRAL ABSCESSES AND CRANIAL. NERVE PALSIES IN MENINGOCOCCAL M E N I N G I T I S . CThomas’, N . Strickland2 a n d J. Friedland’, Departments of Infectious Diseases’ and Radiolo&, Hammersmith Hospital, London. Hisfory: A 17 year old woman presented with 1 week
history of meningism, complete right, and partial left, 3”nerve palsies. CRP was 104mg/l. A CT scan of her brain was normal, and CSF showed a predominant neutrophilia of 635 WBC/pl. No organisms were seen or grown on culture. In view of her unusual neurology, an MRl scan was performed, and surprisingly multiple enhancing white matter lesions were found, which represented abscesses. An extensive serological and molecular search for a pathogen was negative.
She was
treated with parenteral and then oral broad-spectrum antibiotics. Early follow up MRIs demonstrated little improvement but eventually complete resolution of abscesses. Neisseria meningitidis (NM) was then diagnosed of acute and convalescent serology, 7??e lessons:(i) CT and MRI are not interchangable - to be discussed in the context of the new BIS guidelines (ii) Cerebral nerve palsies due to vasculitis and’ (iii) abscesses are rare presentations of NM which require
extended antibiotic therapy. Key Images: CT on admission, 3 MRl scans
SUEJCLINICAL DEFICITS IN AUDITORY PERFORMANCE FOLLOWING RECOVERY FROM BACTERIAL MENINGITIS
M.Mulheran’, M. Johnstone’, RG Finch’, MJ Wiselk$.
MRC Toxicology Unit, Universi@ of Leicester’, Depb of Infection 4 and Eti8 Leicester Royal Infirmary and Dept of Infection, City Hospital, Nottingham3.
Introduction The risk of hearing loss after proven bacterial meningitis, is well recognised and is conventionally measured using standard pure tone audiometry (PTA), The aim of this study was to employ more sophisticated audiological measurement techniques to identify evidence of any subclinical deficits in auditory performance in this patient group. Methods Patients (n=17) who had recovered from proven bacterial meningitis were recruited from two clinical centres. All patients had initial audiometrical screening by tympanometry and questionnaire in order to exclude any other likely cause of hearing deficit. Patients then performed a battery of tests designed to measure different aspects of auditory function which included: standard PTA (from 025 ld-lz to 8 kHz); High Frequency PTA (HFPTA from 10 kHz to 16 kHz); frequency resolution at 2, 4 and 8kHz; and distortion product otoacoustic emissions (DPOAEs). The results were then compared with similar aged controls (n=44). Results and Conclusions The results from this preliminary study showed that there were significant subclinical deficits in the HFPTA and in measures of frequency resolution. There was also evidence of deficit in the DPOAEs. These effects have implications for our understanding of the development of hearing loss after bacterial meningitis and may be an explanation for the attention and concentration deficits often reported after bacterial meningitis.