Advances in therapy, outcome, and prediction of neurological infections published in the past year are reviewed from the University of Colorado Denver Health Sciences Center. Clinical trials of adjuvant dexamethasone therapy for bacterial meningitis result in a decrease in death rate and fewer unfavorable outcomes, but only in patients with meningitis caused by Streptococcus pneumoniae. Patients with meningitis and coexistent HIV infection are not benefited. Steroids should be reserved for immunocompetent patients with identified CSF gram-positive organism.

In patients with bacterial meningitis, prior antibiotic therapy may decrease the incidence of positive bacterial cultures in CSF and blood but does not decrease the frequency of positive CSF gram stains. Longer therapy is associated with higher CSF glucose and lower protein concentration but no change in CSF white blood cell count. CSF glucose and protein levels cannot be used to distinguish between bacterial and viral meningitis in patients who have received antibiotic pretreatment.

Recovery from neuroinvasive West Nile virus infection may be prolonged, but most patients return to normal functioning within 1 year.

Rapid RNA interference viral testing is successful in identifying novel pathogens in neuroinfectious diseases of unknown cause, leading to early treatment and potential new antiviral therapies. A lymphocytic choriomeningitis-like virus was identified as arenavirus in tissue, blood, and CSF specimens from three organ-transplant recipients who developed a fatal febrile encephalopathy 4-6 weeks after transplantation, when standard diagnostic techniques had failed. [1]

COMMENT. Neuroinfectious disease is an expanding field of investigation, both in acute and in chronic disorders. The role of viral meningitis in the cause of epilepsy has received increasing attention (Ped Neur Briefs 2008;22:75). Maternal infection during pregnancy increases the risk of epilepsy in the offspring (Ped Neur Briefs 2008;22:45). Brain inflammation has a role in epileptogenesis [2].