La Revue du praticien
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La Revue du praticien · Oct 1994
Review[Treatment of bacterial meningitis in newborn infants and children].
Third generation cephalosporin as cefotaxime or ceftriaxone is the best first line treatment. Duration of treatment is 7 to 10 days in uncomplicated disease. Dexamethasone used very early--before or at the same time of the antibiotic injection--seems to decrease sensorial sequelae. ⋯ In newborns, morbidity is higher, due in part to brain abscesses. Therapeutic choice is not the same for materno-foetal and postnatal infection. Antibiotherapy duration is, at least, 15 days and 21 days for gram-negative bacteria.
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Epidemic bacterial meningitis in the adult and the elderly are essentially due to Streptococcus pneumoniae. Neisseria meningitidis and Listeria monocytogenes. ⋯ Treatment associates an antibiotic having rapid antibactericidal action in the CSF, suppression of possible foci of primary infections and intensive care required by the frequency of associated visceral insufficiency. Present research is centered on: 1. the appearance and progression of pneumococcal lines resistant to penicillin; 2. the trials of modulators of the inflammatory response, notably dexamethasone; 3. the improvement of antibiotic concentrations in the CSF and the cerebral parenchyma, particularly in listeria infection.
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Ophthalmologic manifestations of sarcoidosis are multiform, and all parts of the structure of the eyeball can be affected. Involvement of the conjunctiva and of the lacrimal glands is the most frequent and is benign. Uveitis is observed in 20% of patients. ⋯ The possibility of uveitis requires routine investigation in all patients with sarcoidosis. Neuro-ophthalmologic involvement is rare but severe. When isolated, it presents difficult problems of diagnosis.