Approach to the diagnosis and management of tuberculous meningitis.

Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents particular challenges in terms of diagnosis and management. The nonspecific clinical presentation of tuberculous meningitis (TBM) has led researchers to develop newer molecular methods of making the diagnosis. Several of these methods have excellent sensitivity and specificity, although many are not yet available for clinical use.

Characterisation of a Staphylococcus aureus strain with progressive loss of susceptibility to vancomycin and daptomycin during therapy.

Following an initial response to vancomycin therapy, a patient with meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia developed endocarditis, failed a second course of vancomycin and then failed daptomycin therapy. An increase in the vancomycin minimum inhibitory concentrations of four consecutive MRSA blood isolates from 2 microg/mL to 8 microg/mL was shown by Etest. Population analysis of four successive blood culture isolates recovered over the 10-week period showed that the MRSA strain became progressively less susceptible to both vancomycin and daptomycin.

Antimicrobial agents in the treatment of bacterial meningitis.

The use of antimicrobial agents in the treatment of acute bacterial meningitis has undergone significant changes in recent years. There is a wealth of in vitro and animal model data that support the use of the specific antimicrobial agents in the treatment of bacterial meningitis, although not all regimens have been evaluated in clinical trials. Recent investigations have focused on expanding the potential antimicrobial formulary to manage patients with bacterial meningitis effectively in this era of increasing antimicrobial resistance.

Approach to the Diagnosis and Management of Tuberculous Meningitis.

Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents specific challenges in terms of diagnosis and management. The nonspecific clinical presentation of tuberculous meningitis has led researchers to develop newer biochemical and molecular methods of making the diagnosis. Several of these methods have excellent sensitivity and specificity, although are not yet available for clinical use.