title: [Effect of immunoglobulins on the course of therapy-resistant Klebsiella meningitis].
abstract: The case of a 28-year-old patient with refractory Klebsiella meningitis after surgical removal of an angioblastoma in the left cerebellar hemisphere (Lindau's tumour) as described in this article, shows the significance of immunoglobulin therapy in view of the synergistic efficacy increase of antibiotics and immunoglobulin. There were 4 meningitis relapses in a period of 8 months, each time 4 days after discontinuation of antibiotics, the therapy consisting of antibiotics only (penicillin G, gentamycin, lamoxactam, cefotaxim and chloramphenicol). These antibiotics, which were applied in accordance with the antibiogram, were discontinued each 16-32 days after the patient had become afebrile and CSF was free from bacteria. In spite of this, further meningitis relapses followed even when the CSF cell count dropped from 12000/3 to 32/3 cells. An attempt to apply gentamycin suboccipitally failed, since diplopia, nystagmus and headache occurred after a single application. The combination of chloramphenicol orally and immunoglobulin intravenously resulted for the first time in complete freedom from bacteria in the CSF. A single intrathecal application of 1 g immunoglobulin caused a temporary increase in CSF cells to 1200/3 and an anal temperature increase from 37% to 38% C. Urticaria exanthema was observed twice as a side effect of immunoglobulin therapy.
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000601:surgery; D004359:Drug Therapy, Combination; D005260:Female; D006394:Hemangiosarcoma / Q000601:surgery; D006801:Humans; D007116:Immunization, Passive / Q000379:methods*; D007710:Klebsiella Infections / Q000188:drug therapy*; D008581:Meningitis / Q000188:drug therapy*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
vernacular_title: Einfluss von Immunglobulinen auf den Verlauf einer therapie-resistenten Klebsiellen-Meningitis.