Toxin diseases of the CNS

Introduction

Bacterial cells produce two principal types of toxin: exotox-ins and endotoxins. Exotoxins are released by viable organisms or on death of the cell, whereas endotoxins are produced when bacteria undergo autolysis. The former are proteins and generally affect specific tissue, whereas the latter are composed of lipopolysaccharide and protein complex derived from the bacterial cell wall which have a non-specific effect on the host cells. Toxin diseases affecting the nervous system include tetanus, diphtheria, botulism and pertussis. The haemolytic-uraemic syndrome, sta-phylococcal toxic shock syndrome and Shigella encepha-lopathy may also be considered to be toxin-induced diseases (Berkowitz 1989[1]).

Tetanus

Clinical disease follows infection of a wound with the spore-forming Gram-positive bacterium Clostridium tetani. Under suitable anerobic conditions, the spores germinate in tissues, and release a powerful neurotoxin, tetanospasmin. Tetanus may follow any wound, including injection sites and surgical wounds, but most commonly follows penetrating wounds in which the tetanus spores are introduced deep into the tissues. It is usually only possible to recover the tetanus bacilli from 30% of cases. The umbilical cord of newborns is of particular importance as a site of infection in developing countries where neonatal tetanus is a major cause of neonatal mortality (Mukhtar 1987[2]). In rare instances no portal of entry can be found, and in such cases it must be assumed that the wound was so mild as to have been forgotten or so trivial as not to have come to medical attention.

Tetanus usually has an incubation period of 5-14 days, but this can range from 24 hours to 3 weeks (Weinstein 1987[3]). Short incubation cases usually have severe disease, but a long interval does not necessarily exclude severe disease. Disease does not develop until spores are converted to the toxin-elaborating bacillus. The bacilli multiply in the tissues and produce tetanospasmin, a 67 000-dalton protein which is probably absorbed through the motor nerve endings and travels to the anterior horn cells. Symptoms of the disease appear when the toxin reaches the nervous system. The toxin exerts its effect in four areas of the nervous system: the motor end-plate of skeletal muscles, the spinal cord, the brain, and in some cases the sympathetic nervous system.

Tetanus toxin interferes with neuromuscular transmission by blocking release of acetyl-choline from the nerve terminals. Selective blocking of inhibitory synapses in the CNS appears to account for the primary phenomena of tetanus. Unchecked and uncoordinated excitatory impulses multiply and traverse reflex pathways to produce the characteristic tetanic spasms of muscle. The earliest manifestations may be pain and stiffness in the neck and back, but are usually trismus and dysphagia. Rarely, cranial nerve palsies (cephalic tetanus) may be the initial feature. Spasms leading to abdominal rigidity, extension of limbs and opisthotonos may be spontaneous or induced by the most trivial of stimuli, such as noise, sudden movements or bright light. They increase in frequency and duration to cause impairment of respiratory function. Death may occur from respiratory obstruction, by secretions, or as a consequence of impaired respiratory muscle function. Fever is not common, but indicates a poor prognosis if present. If the initial spasms are generalized, the prognosis is also poor. The more severe cases also develop problems arising from the syndrome of sympathetic overactivity. Profuse sweating and salivation, fever, hypertension and tachycardia or arrhythmias, together with peripheral vaso-constriction, are the principal features.

Neonatal tenanus

Neonatal tetanus is a serious problem in less-developed countries (Melgaard et al 1988[4]). It is usually a consequence of infection of the umbilical stump due to poor hygiene or the practice of application of mud or dung to the umbilical stump (Mukhtar 1987[2]). The disease has its onset within 14 days of birth and may commence as early as 4 days. The early signs are constipation, difficulty in feeding or swallowing, and the mother may state that the infant does not cry properly or has difficulty in opening his mouth. Convulsions or cyanotic attacks may be prominent. Soon, the more easily recognized generalized spasms develop, which are readily provoked by noise, light or handling. The highest mortality occurs in premature infants and in those of low birth weight. If symptoms start within 7 days of birth, or if autonomic nervous system disturbance is prominent, the duration of the illness can be up to 4 weeks. Neonatal tetanus must be distinguished from seizures due to intracranial birth trauma, hypoglycaemia, meningitis and kernicterus.

Management of tetanus

The management of tetanus involves neutralization of toxin still present in the blood; antibiotics; surgical treatment of any persisting infection; and intensive support to control the spasms and maintain respiration (Adams et al 1979[5]). The toxin, once fixed in the tissues, cannot be inactivated by antitoxin. The antitoxin is therefore only of use in neutralizing toxin which is still in the bloodstream or in the tissues. The antitoxin of choice is human hyperimmune globulin in a dose of 30 300 U/kg given by intramuscular injection. If human hyperimmune globulin is not available, equine antitoxin can be given in doses of up to 100 000 U, with half this dose being given intravenously and half intramuscularly. A test dose should first be administered to ensure that there is no hypersensitivity to horse serum. Penicillin should be administered parenterally to kill any persisting vegative forms of Clostridium tetani. The site of entry of the organism should be treated surgically to remove any infected tissue (Weinstein 1987[3]).

Success in the management of tetanus depends on the skill and experience of the medical team. Experience will enable the appropriate interventions to be taken at the optimal time, while avoiding unnecessary procedures which may themselves produce complications. Patients with mild disease, namely those in whom the incubation period exceeds 14 days and in whom the generalized spasms may take a week to evolve, can usually be managed by sedation and careful nursing. More severe cases will require intubation or tracheostomy and the use of diazepam and other sedatives to reduce spasms. Difficulty in coping with secretions in the upper airways is an indication for intubation or tracheostomy. Severe cases should be managed in an intensive care unit as with intensive support most patients can recover from the disease. Pharmacological alpha- and beta-adrenergic blockade has been advocated for patients who exhibit the syndrome of sympathetic overactivity, but this treatment is not without danger. An outline of the management of tetanus of varying degrees of severity is shown in Table 22.25

Table 22.25

.

Prevention

Tetanus is a preventable disease. Active immunization is readily achieved by means of either fluid or alum-precipitated toxoid. Three injections of the latter given 4 weeks apart have proved highly effective. Circulating antitoxin is detectable within one week after the second dose of the alum and the third dose of the fluid toxoid. Protective levels of antibody are present in the serum for 5-10 years after the last dose of toxoid has been given. A booster dose of toxoid is therefore recommended every 10 years if no wounds have been incurred, but fully immunized individuals exposed to infected wounds should have a booster injection if 5 or more years have elapsed since the last one. Neonatal tetanus can be prevented by immunizing pregnant women, but in addition attempts to improve general hygiene and umbilical stump care are important public health measures to reduce the incidence of the disease. Non-immunized children who sustain wounds require immediate protection. Prophylactic penicillin is inadequate protection against the development of tetanus, and tetanus immune globulin is therefore required. Human immune globulin should be given in a dose of 250-350 U. Active immunization should be commenced at the same time to provide permanent immunity (Mc Comb & Dwyer 1963[6]). Patients who have suffered from tetanus should also be given tetanus vaccine as the disease does not confer immunity.

Diphtheria

Immunization has been the single most important factor in the control of diphtheria, but protection requires a full course of vaccine. Incomplete immunization courses may leave the individual unprotected. The diphtheria bacillus is a club-shaped Gram-positive rod, some strains of which produce an exotoxin which binds to specific cell receptors which are present on all human cells. The toxin causes tissue necrosis, thus causing the local membrane formed at the site of multiplication in the upper respiratory tract; infection may also occur on other surfaces such as the skin, auditory canal, conjunctiva and vulvo-vaginal region. The toxin is poorly absorbed but is responsible for the myo-cardial injury.

The neurological disturbances in diphtheria are stated to be caused by a polyneuritis which results in muscle paralysis, but the precise mechanisms of paralysis are not known. Paralysis occurs in about 10% of patients and is usually symmetrical, occurring after the first week of the illness . The most frequent manifestation is palatal paralysis, but the extraocular muscles and muscles of accommodation may also be involved. Less commonly, the diaphragm and pharyngeal muscles may be affected and rarely limb paralysis occurs. These latter paralyses occur 6-8 weeks after the onset of infection. Some individuals may have a disorder closely resembling the Guillain-Barre syndrome. Most paralytic episodes resolve after 3-4 weeks and it is a characteristic that recovery is complete. The treatment of diphtheria is based on neutralization of free toxin by the use of antitoxin and elimination of the organism by use of antibiotics. Good supportive care, particularly if laryngeal obstruction, myocarditis or paralysis has occurred, is essential (Feigin & Stechenberg 1987[7]).

Botulism and infantile botulism

Botulism is an acute descending flaccid paralysis that results when the neurotoxin of Clostridium botulinum induces neuromuscular blockade. Three forms of botulism exist. The infant form, which is the most common, occurs when spores of Clostridium botulinum are ingested by an infant, colonize the intestinal lumen, and produce botulinal toxin (Dowell 1984[8]). Both the organisms and toxins are found in the infant's faeces, and the infant is usually the only family member who is ill. Food-borne botulism occurs when toxin-producing organisms multiply in improperly processed foods. Outbreaks of this disorder are usually traceable to specific foods, especially home-processed canned foods. In an outbreak in the UK in 1989, 18 cases occurred within a 2-week period. Consumption of yogurt containing hazelnut puree was implicated as the cause (Communicable Diseases Report 1989[9]). Wound botulism results from the infection of traumatized tissue by C. botulinum and subsequent toxin production.

There are seven antigenically distinct types of botulin toxin, designated types A-G. The toxin is heat-labile, being destroyed by boiling for 5 minutes. The toxin is absorbed from the intestine or an infected wound into the lymphatics, after which it is haematogenously distributed to the peripheral cholinergic nerve synapses, usually at the neuromuscular junction. The toxin does not cross the blood-brain barrier. The nerve endings take up the toxin, which then irreversibly blocks acetylcholine release and results clinically in flaccid paralysis. The cranial nerves are affected earliest and often most severely. Death occurs from respiratory muscle paralysis or its complications such as cardiac arrhythmia, aspiration or pneumonia.

The illness usually presents as a descending symmetrical motor paralysis, first affecting the cranial nerves. There is no impairment of consciousness and there are no sensory disturbances. Common symptoms include diplopia, dys-arthria and dysphagia. Patients with type E botulism also have gastrointestinal symptoms including nausea, vomiting and abdominal distension. Respiratory involvement is common and postural hypotension, nystagmus and somnolence may also occur. The usual interval between food ingestion and the onset of symptoms is 18-36 hours and in general the patients with shorter incubation periods are more severely affected.

Infant botulism was first described by Picket et al in 1976[10] and is characterized by weakness and paralysis of cranial nerves and limbs which develops slowly over a period of days. There is often a history of preceding constipation and the infant has difficulty in feeding and respiratory embarrassment. Mild forms of the disease show only hypotonia, hyporeflexia and feeding difficulties. In more severely affected infants there may be severe generalized weakness with ptosis, facial diplegia, extraocular palsies and a poor gag reflex (Fig. 22.17)

Fig 22.17

. In severe forms, deterioration may be rapid and may superficially resemble the sudden infant death syndrome (Arnon 1980)[11].

Recovery takes place over a period of several weeks, but some weakness may persist for months. The disease has been most commonly reported in the USA but also occurs in other countries. Most cases have been associated with the type B organism and the majority have occurred in the western areas of the USA. Food sources have been sought, but the only food which has consistently been associated with the disorder is honey. In the vast majority of cases no food or environmental source can be found (Istre et al 1986)[12].

The diagnosis is established by demonstrating the specific toxin in stool and isolating the organism. In contrast to adult forms of the disease, the toxin is usually not detected in the circulation in the infantile form. Electromyographic changes have been described consisting of brief, small-amplitude abundant motor unit potentials, with augmentation of the amplitude by the evoked muscle action potential at stimulation frequencies greater than 10 Hz; most cases show a positive incremental response, but this is also seen in other disorders such as snake-bite and antibiotic toxicity. Meticulous supportive care is the most important aspect of treatment. Conclusive evidence that antitoxin is effective is lacking, and there is no evidence that this treatment is useful in infantile forms of the disorder. Antibiotics directed against intraluminal C. botulinum are not used because bacterial death and lysis may liberate additional toxin into the gut. Careful monitoring and tube-feeding is all that is required in most affected infants, but intubation and ventilation may be required in more severely affected cases (Finegold & Arnon 1987[13]).

Pertussis

Pertussis is caused by the bacteria Bordatella pertussis and Bordatella parapertussis. These organisms colonize the respiratory tract, and appear to induce the characteristic syndrome of spasmodic cough by the elaboration of toxins rather than by invasion of the tissues. Pertussis can therefore be included amongst the disorders mediated by bacterial toxins. A large number of different toxins are produced by pertussis, including a heat-labile toxin with dermonecrotic activity, adenylcyclases, tracheal cytotoxins which paralyze cilia of the respiratory epithelium, haemo-lysin and endotoxins. 'Pertussis toxin' is probably a single substance which has diverse effects including histamine-sensitizing activity, lymphocytosis-promoting activity and islet cell-activating activity. The exact role played by these toxins in inducing the clinical syndrome is not yet clear, nor is it certain that antibodies against any of these individual toxins would prevent the illness (Preston 1988[14]).

In most children the pertussis syndrome is a purely respiratory illness, with severe spasmodic cough, often followed by vomiting, facial congestion and the characteristic whoop'. However, in severely affected children, the coughing spasms may induce hypoxia of sufficient degree to result in convulsions and loss of consciousness. Severe venous congestion may also result in petechiae or cerebral haemorrhages. Pertussis encephalopathy is an ill-defined condition, occurring predominantly in very young children (Zellweger 1959[15]). Affected infants may develop convulsions, coma and sometimes hemiplegia. Although hypoxia and petechiae in the brain may account for some of these features, there is no proof of this in many cases (Celermajer & Brown 1966[16]). A direct effect of some of the toxins on the brain may also be involved and hypoglycaemia may contribute to the CNS damage in some cases. Residual neurological damage is well documented in patients with severe apnoea, convulsions or encephalopathy, and subsequent intellectual development may be impaired (Olson 1975[17]). However, it is rare for developmental sequelae to occur in children with uncomplicated pertussis (Johnston et al 1985[18]).

The possible role of pertussis vaccination in the causation of acute neurological disorder has been the subject of intense debate (Ross 1988, Miller et al 1982[19, 20]). Initial uncontrolled reports of encephalopathy following pertussis vaccination aroused considerable concern about the safety of pertussis vaccine, and resulted in a decline in vaccine uptake in several countries. A major difficulty in assessing the risk of neurological damage after pertussis immunization is the high incidence of encephalopathy occurring in the first year of life, when most vaccinations are administered. A nationwide case-controlled study of all children with encephalopathy was undertaken in the UK between 1976 and 1979 to address the question of pertussis-induced encephalopathy. The results of the study (Miller et al 1981[21]) indicated that there was a relatively higher risk of children suffering from an acute neurological illness in the 7 days following immunization with diphtheria, tetanus and pertussis vaccine than in control cases. The attributable risk of serious neurological reaction was 1 per 110 000 immunizations, and that of neurological damage persisting in one year was 1 per 310 000 immunizations. Although there does appear to be a small increased risk of neurological damage induced by pertussis vaccination, this must be weighed against the mortality and neurological damage induced by the disease in unvaccinated children (Miller et al 1982[20]). At present there is no doubt that the benefits of pertussis immunization far outweigh the small risk of inducing neurological illness. Newer acellular pertussis vaccines have been developed which are now undergoing clinical evaluation in several countries. Preliminary data suggest fewer side effects and better immunogenicity and they may prove to be superior to the current whole-cell vaccines (Poland 1996[22]).

Staphylococcal toxic shock syndrome

The staphylococcal toxic shock syndrome was first described by Todd et al in 1978[23]. It is characterized by fever, shock and hypotension, conjunctival injection, ulcer-ation and erythema of the oropharynx, diffuse macular erythroderma, with desquamation 1-2 weeks after onset of the illness, and multisystem involvement. CNS manifestations are prominent and include disorientation, coma, convulsions and severe encephalopathy. Renal and hepatic malfunction are common, as are thrombocytopenia and disseminated intravascular coagulation (Chesney 1989[24]).

The disorder is most commonly seen in association with menstruation and tampon use in young adult women. However, it also occurs in children of all ages (Broome 1989[25]). Toxic shock syndrome is now known to be induced by a toxin: (TSS-1) toxic shock toxin 1 - and possibly other toxins produced by strains of Staphylococcus aureus (Schlievert 1989[26]). Although the illness is frequently life-threatening, recovery usually occurs with good intensive care, eradication of the causative organism with antibiotics and support of the multisystem failure. Long-term neurological damage is rare, even in children who have severe encephalopathy.

Haemolytic uraemic syndrome (HUS)

HUS is characterized by acute renal failure, micro-angiopathic haemolytic anaemia and thrombocytopenia (Levin 1989[27]). In recent years there has been increasing recognition that the CNS is commonly involved by the microangiopathic process, and considerable morbidity and mortality may result from the neurological involvement. Most cases of HUS in children in developed countries are caused by verotoxin-producing E. coli, but in developing countries Shigella dysenteriae, which produces an identical toxin to verotoxin, is the usual cause (Levin et al 1989a[28]). The neurological manifestations include convulsions, focal neurological signs, hemiplegia and cerebral oedema. His-topathological findings include cerebral microangiopathy and infarction due to vascular occlusion. Supportive treatment with dialysis and blood transfusion and control of hypertension are usually effective, but plasma exchange and antiplatelet agents have been used in children with severe encephalopathy (Upadhyaya et al 1980, Sheth et al 1986[29, 30]).

References

1. Berkowitz F 1989 Bacterial exotoxins: how they work. Pediatric Infectious Disease Journal 8: 42-47
2. Mukhtar M Y 1987 Birth care practice and tetanus neonatorum a hospital-based study in Mosul. Public Health 101: 453-456

3. Weinstein L 1987 Tetanus. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, London, pp 1126-1134

4. Melgaard B, Mutie D M, Kimani G 1988 A cluster survey of mortality due to neonatal tetanus in Kenya. International Journal of Epidemiology 17: 174-177

5. Adams J M, Kenny J D, Rudolph A J 1979 Modern management of tetanus neonatorum. Pediatrics 64: 472-477

6. Mc Comb J A, Dwyer R C 1963 Passive-active immunization with tetanus immune globulin. New England Journal of Medicine 268: 857-862

7. Feigin R D 1987 Bacterial meningitis beyond the neonatal period. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 439-465

8. Dowell V R 1984 Botulism and tetanus: selected epidemiologic andmicrobiologic aspects. Reviews of Infectious Diseases 6 (suppl. 1): 5202-5207

9. Communicable Diseases Report 1989 23:Communicable Diseases Surveillance Centre 1984 Virus meningitis and encephalitis 1978-1982.

10. Picket J, Berg B, Chaplin E et al 1976 Syndrome of botulism in infancy: clinical and electrophysiologic study. New England Journal of Medicine 295: 770-772

11. Arnon S S 1980 Infant botulism. Annual Reviews in Medicine 31:541-560

12. Istre C R, Compton R, Novotney T et al 1986 Infant botulism: three cases in a small town. American Journal of Diseases in Children 140:1013-1014

13. Finegold S M, Arnon S S 1987 Clostridial intoxication and infection. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 1118-1125 fischer1981 #Fischer E G, McLennan J E, Suzuki Y 1981 Cerebral abscess in children. American journal of disease in Children 135: 746-749

14. Preston N W 1988 Pertussis today. In: Wardlaw A C, Parton R (eds) Pathogenesis and immunity in pertussis. Wiley, Chichester

15. Zellweger H 1959 Pertussis encephalopathy. Archives of Pediatrics 76: 381-386

16. Celermajer J M, Brown J 1966 The neurological complications of pertussis. Medical Journal of Australia 1: 1066-1069

17. Olson L C 1975 Pertussis. Medicine 54: 427-469

18. Johnston I D, Anderson H R, Lambert H P et al 1985 Reading attainment and physical development after whooping cough. Journal of 1Epidemiology and Community Health 39: 314-319

19. Ross E M 1988 Reactions to whole cell pertussis vaccine. In: Wardlaw A C, Parton R (eds) Pathogenesis and immunity in pertussis. Wiley, Chichester, pp 375-398

20. Miller D L, Alderslade R, Ross E M 1982 Whooping cough and whooping cough vaccine: the risks and benefit debate. Epidemiology Reviews 4: 1-24

21. Miller D L, Ross E M, Alderslade R et al 1981 Pertussis immunization and serious acute neurological illness in childhood. British Medical Journal 1: 1595-1599

22. Poland G A 1996 Acellular pertussis vaccines: new vaccines for an old disease. Lancet 347: 209-210

23. Todd J, Fishaut M, Kapral F et al 1978 Toxic shock syndrome associated with phage group 1 staphylococci. Lancet 2: 1116-1118

25. Broome C V 1989 Epidemiology of toxic shock syndrome in the United States: overview. Reviews of Infectious Diseases 11 (suppl): 14-21

26. Schlievert P M 1989 Role of toxic shock syndrome. Toxin 1 in toxic shock syndrome. Reviews of Infectious Disease 11 (suppl): 107-109

27. Levin M 1989 Treatment of meningitis. Current Medical Literature, Paediatrics 2: 3-8

28. Levin M, Walters M D S, Barratt T M 1989a Hemolytic uremic syndrome. Advances in Pediatric Infectious Diseases 4: 51-82

29. Upadhyaya K, Berwick K, Fishaut M 1980 The importance of non-renal involvement in hemolytic uremic syndrome. Pediatrics 65: 115-120

30. Sheth K J, Swick H M, Hawarth N 1986 Neurological involvement in hemolytic uremic syndrome. Annals of Neurology 19: 90-93

31. Abbott J D, Jones D M, Painter M J et al 1985 The epidemiology of meningococcal infections in England and Wales 1912-1983. Journal of Infection 11: 241-257

32. Abramovitz P, Schuartzman P, Harel D et al 1987 Direct invasion of the central nervous system by Mycoplasma pneumoniae: a report of two cases. Journal of Infectious Diseases 155: 482-487

33. Aikawa M, Iseki M, Barnwell J W et al 1990 The pathology of human cerebral malaria. American Journal of Tropical Medicine Hygiene

34. Alford C A, Stagno S, Pass R 1980 Natural history of perinatal cytomegaloviral infection. In: Perinatal infections. Ciba Symposium 77: 125-147

35. Alkalay A L, Pomerance J J, Rimoin D C 1987 Fetal varicella syndrome. Journal of Pediatrics 11 1: 320-323

36. American Academy of Pediatrics 1991 Report of the Committee of Infectious Diseases, Elk Grove Village, Illinois. Leprosy 290-292

37. American Academy of Pediatrics 1994 Report of the Committee of Infectious Diseases, Elk Grove Village, Illinois, 23rd edn. Herpes simplex 242-252

38. American Academy of Pediatrics 1994 Report of the Committee on Infectious Diseases, Elk Grove Village Illinois, 23rd edn. Tuberculosis, 480-500

39. Ames M D, Plotkin S A, Winchester R A et al 1970 Central auditory imperception: a significant factor in congenital rubella deafness. Journal of the American Medical Association 1970: 419-421

40. Anders B J, Laurer B A, Foley L C 1980 Computerised tomography to define CNS involvement in congenital cytomegalovirus infection. American Journal of Diseases of Children 134: 795-797

41. Anderson J R 1988 Viral encephalitis and its pathology. Current Topics in Pathology 76: 23-60

42. Andiman W A 1986 Lyme disease: epidemiology, etiology, clinical spectrum, diagnosis and treatment. Advances in Pediatric Infectious Disease 1: 163-186

43. Anonymous Editorial 1992 Ocular complications in leprosy. Lancet 340:642-643

44. Arditi M, Manogue K R, Caplan M et al 1990 Cerebrospinal fluid cachectin/tumor necrosis factor-a and platelet activating factor concentrations and severity of bacterial meningitis in children. Journal of Infectious Diseases 162: 139-147

45. Arya T V, Prasad R N, Bhandari S et al 1989 Spontaneous and quinine induced hypoglycaemia in severe falciparum malaria. Tropical Geography and Medicine 41(1): 73-75

46. Aszkenazy 0 M, George R C, Begg N T 1995 Pneumococcal bacteraemia and meningitis in England and Wales 1982-1992. Communicable Disease Report 5: R45-50

47. Aurelius E, Johansson B, Skoldenberg B et al 1991 Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet. 337: 189-192

48. Austrian R, Lukens J, Seeler R A 1972 Pneumococcal infections in sickle cell anemia. American Journal of Disease in Childhood 123: 614-615

49. Baker C J 1971 Primary spinal epidural abscess. American Journal of Diseases of Children 121: 337-339

50. Band J D, Clegg H W, Hayes P S 1981 Transmission of group B streptococci: traced by use of multiple epidemiologic markers. American Journal of Diseases in Children 135: 355-358

51. Bare D U, Wood R P, Stears et al 1985 Subarachnoid space: middle ear pathways and recurrent meningitis. American Journal of Otology 6:157-163

52. Barnwell J W, Asch A S, Nachman R L et al 1989 A human 88-kD membrane glycoprotein (CD36) functions in vitro as a receptor for a cytoadherence ligand on Plasmodium falciparum-infected erythrocytes. Journal of Clinical Investigation 84(3): 765-772

53. Bastian F 0, Rabson A S, Lee C Y et al 1972 Herpes virus hominis: isolation from human trigeminal ganglion. Science 178: 306-307

54. Bayston R 1989 Hydrocephalus shunt infections. Chapman & Hall, London

55. Bellman M H, Dick G 1980 Surveillance of subacute sclerosing panencephalitis. British Medical Journal 2: 393-394

56. Belman A L, Lantos G, Horoupian D et al 1986 AIDS: calcification of the basal ganglia in infants and children. Neurology 36: 1192-1199

57. Belman A L, Ultmann M H, Horoupian D et al 1985 Neurological complications in infants and children with acquired immune deficiency syndrome. Annals of Neurology 18: 560-566

58. Bergen D, Grossman H 1976 Infectious mononucleosis as a cause of acute cerebellar ataxia of childhood. Developmental Medicine and Child Neurology 18: 799-802

59. Berger J R, Kaszovitz B, Donovan-Post M J et al 1987 Progressive multifocal leukoencephalopathy associated with human immunodeficiency virus: a review of the literature with a report of sixteen cases. Annals of Internal Medicine 107: 78-87

60. Bernstein L J, Krieger B Z, Novick B 1985 Bacterial infection in the acquired immunodeficiency syndrome of children. Pediatric Infectious Diseases 4: 472-475

61. Bhagavati S, Ehrlich G, Kula R W et al 1988 Detection of human T cell lymphoma/leukemia virus type I DNA and antigen in spinal fluid and blood of patients with chronic progressive myelopathy. New England Journal of Medicine 318: 1141-1147

62. Bhagwati S N, Parulekar G D 1986 Management of intracranial tuberculoma in children. Child's Nervous System 2: 32-34

63. Bierman F Z, Gersony W M 1987 Kawasaki disease, clinical perspective. Journal of Pediatrics II 1: 789-792

64. Bittencourt A L 1976 Congenital Chagas disease. American Journal of Diseases of Children 130: 97-103

65. Blake K, Pillay D, Knowles W et al 1992 JC virus associated meningoencephalitis in an immunocompetent girl. Archives of Disease in Children 67: 956-957

66. Boom W H, Tuazon C U 1985 Successful treatment of multiple brain abscess with antibiotics alone. Reviews of Infectious Diseases 7: 189-199

67. Borchelt D R. Taraboulos A Prusiner S B 1992 Evidence for synthesis of scrapie prion proteins in the endocytic pathway. Journal of Biological Chemistry 267: 6188-6199

68. Bouma G J, Muizelaar J P 1990 Relationship between cardiac output and cerebral blood flow in patients with intact and impaired autoregulation. Journal Neurosurgery 73: 368-374

69. Brenneman D E, Westbrook G L, Fitzgerald S P et al 1988 Neuronal cell killing by the envelope protein of HIV and its prevention by vasoactive interstinal peptide. Nature 335: 639-642

70. Brew B J, Price R W 1988 Another retroviral disease of the nervous system: chronic progressive myelopathy due to HTLV-1. New England Journal of Medicine 318: 1195-1197

71. Brewster D R, Kwiatkowski, D, White N J 1990 Neurological sequelae of cerebral malaria in children. Lancet 336 (8722): 1039-1043

72. Brisson-Noel A, Aznar C, Chureau C et al 1991 Diagnosis of tuberculosis by DNA amplification in clinical practice evaluation. Lancet 338:364-366

73. Britt R H, Enzmann D R 1983 Clinical stages of human brain abscesses on serial CT scans after contrast infusion: computerized tomographic, neuropathological and clinical correlations. Journal of Neurosurgery 59:972-989

74. Brody J A, Detels R 1970 Subacute sclerosing panencephalitis: a zoonosis following aberrant measles. Lancet 2: 500-501

75. Broughton C R 1964 Morbilli in Sydney 11. Neurological sequelae of morbilli. Medical Journal of Australia 908-915

76. Brown R E 1967 Prevention of leprosy: new ideas out of Africa. Clinical Pediatrics (Phila) 6: 446-450

77. Browne S G 1965 Some less common neurological findings in leprosy. Journal of Neurological Science 2: 253-261

78. Brunell P A, Kotchmar G S 1981 Zoster in infancy: failure to maintain virus latency following intrauterine infection. Journal of Pediatrics 98:71-73

79. Buchanan C R, Preece M A, Milner R D G Mortality, neoplasia and Creutzfeldt-Jakob disease in patients treated with pituitary growth hormone in the United Kingdom. British Medical Journal 302:824-828

80. Bullock W E 1968 Studies of immune mechanisms in leprosy. Depression of delayed allergic responses to skin test antigens. New England Journal of Medicine 278: 298-301

81. Bullock W E 1990. Mycobacterium leprae In: Mandel C L (ed.) Principles and practice of infectious diseases. Douglas

82. Burgdorfer W,Barbour A G, Hayes S F et al 1982 Lyme disease: a tick borne spirochetosis. Science 216: 1317-1319

83. Burman L A, Norrby R, Trollfors B 1985 Invasive pneumococcal infections: incidence, predisposing factors and prognosis. Reviews of Infectious Dieases 7: 133-142

84. Burroughs M, Cabellos C, Prasad S et al 1992 Bacterial components and the pathophysiology of injury to the blood-brain barrier: does cell wall add to the effects of endotoxin in gram-negative meningitis? Journal of Infectious of Disease 165: S82-85

85. Burroughs M, Prasad S, Cabellos C et al 1993 The biologic activities of peptidoglycan in experimental Haemophilus influenzae meningitis. Journal of Infectious Disease 167: 464-468

86. Cain A R, Wiley P F, Brownell R et al 1981 Primary amoebic meningoencephalitis. Archives of Disease in Childhood 56: 140-143

87. Carrera R, Dowling E, Guevara J 1975 Surgical treatment of hydatid cysts of the central nervous system in the pediatric age. Child's Brain 1: 4-21

88. Carter A 0, Frank J W 1986 Congenital toxoplasmosis: epidemiologic features and control. Canadian Medical Association journal 135:618-623

89. Chang K H, Han M H, Roh J K et al 1990 Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT American journal of Neurological Research 154: 69-76

90. Cherry J D 1987a Aseptic meningitis and viral meningitis. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 478-484

91. Cherry J D 1987b Enteroviruses: polioviruses (poliomyelitis, Coxsackieviruses, echoviruses and enteroviruses). In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 1729-1790

92. Cherry J D, Shields W D 1987 Encephalitis and meningoencephalitis. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 484-496

93. Chesebro B, Race R, Wehrly K et al 1985 Identifications of scrapie prion protein-specific mRNA in scrapie-infected and uninfected brain. Nature 315: 331-333

94. Chesney J C, Hodgson G E 1980 CSF eosinophilia during acute Coxsackie B4 viral meningitis. American Journal of Diseases in Children 134: 703

95. Chesney P J 1989 Clinical aspects and spectrum of illness of toxic shock syndrome: overview. Reviews of Infectious Disease II (suppl. 1): 1-7

96. Chesney P J, Chesney R W 1989 Hemorrhagic shock and encephalopathy: reflections about a new devastating disorder that affects normal children. Journal of Pediatrics 114: 254-256

97. Chesney P J, Ketcher M L, Nelson D B et al 1979 CSF eosinophilia in chronic lymphocytic choriomeningitis virus meningitis. Journal of Pediatrics 94: 750-752

98. Chess S 1971 Autism in children with congenital rubella. Journal of Autism and Childhood Schizophrenia 1: 33-47

99. Chin J 1990 Current and future dimensions of the HIV/AIDS pandemic in women and children. Lancet 336: 221-224

100. Clark I A, Chaudhri G, Cowden W B 1989 Roles of tumour necrosis factor in the illness and pathology of malaria. Transcriptions of Royal Society Tropical Medicine and Hygiene 83(4): 436-440

101. Clark I A, Rockett K A, Cowden W B 1992 Possible central role of nitric oxide in conditions clinically similar to cerebral malaria. Lancet 340(8824): 894-896

102. Clyde W A 1980 Neurological syndromes and mycoplasmal infections. Archives of Neurology 37: 65-66

103. Cobb W A, Morgan Hughes J A 1968 Non-fatal subacute sclerosing leucoencephalitis. Journal of Neurology, Neurosurgery and Psychiatry 31: 115-123

104. Cochi S L, Fleming D W, Hightower A W 1986 Primary invasive Haemophilus influenzae type B disease: a population-based assessment of risk factors. Journal of Pediatrics 108: 887-896

105. Communicable Disease Report 39: 3-4 Communicable Diseases Report Weekly 1995 Notifications to OPCS of meningitis and meningococcal infections in England and Wales 5(52): 303

106. Congeni B L, Bradley J, Hammerschlag M R 1986 Safety and efficacy of once daily ceftriaxone for the treatment of bacterial meningitis. Pediatric Infectious Disease journal 5: 293-297

107. Connolly J H, Allen I V, Hurwitz L J et al 1967 Measles-virus antibody and antigen in subacute sclerosing panencephalitis. Lancet 1: 542-544

108. Cooper L Z 1985 The history and medical consequences of rubella. Reviews of Infectious Diseases 7 (suppl. 1): 52-510

109. Corey L, Whitley R J, Stone E F et al 1988 Difference between herpes simplex virus type 1 and type 2 neonatal encephalitis in neurological outcome. Lancet 1: 2-4

110. Costantino P, Viti S, Podda A et al 1992 Development and phase 1 clinical testing of a conjugate vaccine against meningococcus A and C. Vaccine 10: 691-698

111. Crawford C T 1968 Neurological lesions in leprosy. Leprosy Review 399: 9

112. Curless R G, Scott G B, Post M J et al 1987 Progressive cytomegalovirus encephalopathy following congenital infection in an infant with acquired immunodeficiency syndrome. Child's Nervous System 3: 255-257

113. Daffos F, Forestier F, Capella-Pavlovsky M, Thulliez P, Aufrant C, Valenti D, Cot W L 1988 Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis. New England Journal of Medicine 318:271-275

114. Dalgleish A, Weiss R A 1987 Human retroviruses. In: Zuckerman A J, Banatvala J E, Pattison J R (eds) Principles and practice of clinical virology. Wiley, Chichester, pp 517-543

115. Damany B J 1982 Surgery in tuberculous meningitis. Progress in Pediatric Surgery 15: 181-185

116. Daniel T M 1988 Antibody and antigen for the immunodiagnosis of tuberculosis: Why not? What more is needed? Where do we stand? Journal of Infectious Diseases 158: 678-680

117. Daniel T M, Debanne S M 1987 The serodiagnosis of tuberculosis and other mycobacterial diseases by enzyme-linked immunosorbent assay. American Review of Respiratory Diseases 135: 1137-1151

118. Dash M S 1968 A study of the mechanisms of cutaneous sensory loss in leprosy. Brain 91: 379-392

119. Davis J M, David K R, Kleinman G M 1978 Computed tomography of herpes simplex encephalitis with clinicopathological correlation. Radiology 129: 409-417

120. Dawood A A, Moosa A 1984 Cerebral cysticercosis in children. Journal of Tropical Paediatrics 30: 136-139

121. Dawson J R 1934 Cellular inclusions in cerebral lesions of epidemic encephalitis. Archives of Neurology and Psychiatry 31: 685-700

122. De Louvois J, Gortvai P, Hurley R 1977 Bacteriology of abscesses of the central nervous system: a multicentre prospective study. British Medical journal 11: 981-984

123. De Nicola L K, Hanshaw J B 1979 Congenital and neonatal varicella. Journal of Pediatrics 94: 175-176

124. De Wals P, Hertoghe L, Borlee-Grimee I et al 1981 Meningococcal disease in Belgium. Secondary attack rate amongst household, day-care nursery and pre-elementary school contacts. Journal of Infection 3 (suppl. 1): S53-61

125. Dean j M, Rogers M C, Traystman R J 1992 Pathophysiology and clinical management of the intracranial vault. In: Rogers M C (ed.) Textbook of pediatric intensive care. Williams & Wilkins, Baltimore, pp 639-666

126. DeCarli C, Fugate K, Falloon J et al 1991 Brain growth and cognitive improvement in children with human immunodeficiency virus- induced encephalopathy after 6 months of continuous infusion zidovudine therapy. Journal of Acquired Immune Deficiency Syndrome 4: 585-592

127. Desmond M M, Fisher E S, Vordeman A L et al 1978 The longitudinal course of congenital rubella encephalitis in non-retarded children. Journal of Pediatrics 93: 584-591

128. Desmond M M, Wilson G S, Melnick J L et al 1976 Congenital rubella encephalitis. Journal of Pediatrics 71: 311-331

129. Desmonts G, Couvreur J 1975 Toxoplasmosis: epidemiologic and serologic aspects of perinatal infections. In: Krugman S, Gershon A A (eds) Infections of the fetus and the newborn infant. Liss, New York, vol 3, p 118

130. Deutman A F, Grizzard W S 1978 Rubella retinopathy and subretinal neovascularization. American Journal of Ophthalmology 85: 82-87

131. Dezateux C, Dinwiddie R J 1986 Dangers of lumbar puncture. British Medical journal I: 827-828

132. Dismukes W E 1988 Cryptococcal meningitis in patients with AIDS. Journal of Infectious Diseases 157: 624-628

133. Doane F W, Anderson N, Chatiyanonda K et al 1967 Rapid laboratory diagnosis of paramyxovirus infections by electron microscopy. Lancet 2: 751-753

134. Dodge P R, Swartz M N 1965 Bacterial meningitis: a review of selected aspects. 11: Special neurological problems, post-meningitic complications and clinicopathological correlations. New England Journal of Medicine 272: 1003-1010

135. Doern G V 1995 Resistance among respiratory pathogens in paediatrics. Paediatric Infectious Diseases journal. 14: 420-423

136. Dudgeon J A 1967 Maternal rubella and its effect on the foetus. Archives of Disease in Childhood 42: 110-125

137. Dreyer E B, Kaiser P K, Offerman J T et al 1990 HIV -1 coat protein neurotoxicity prevented by calcium channel antagonists. Science 248:364-367

138. Duffy G P 1969 Lumbar puncture in the presence of increased intracranial pressure. British Medical Journal I: 407-409

139. Earnest M P, Barth Relier L, Filley C M et al 1987 Neurocysticercosis in the United States: 35 cases and a review. Reviews of Infectious Diseases 9: 9617-9619

140. Editorial 1985 Haemorrhagic shock and encephalopathy. Lancet 2:535-536 Editorial 1988 Penicillin resistant pneumococci. Lancet: 1142-1143

141. Ellard G A, Humphries M J, Allen B W. 1993 Cerebrospinal fluid concentrations and the treatment of tuberculous meningitis. Am Rev Respir Dis. 148: 650-655

142. Ellison R T, Kohler P F, Curd J G 1983 Prevalence of congenital or acquired complement deficiency in patients with sporadic meningococcal disease. New England Journal of Medicine 308:913-916

143. Enders G 1985 Serologic test combinations for safe detection of rubella infections. Reviews of Infectious Diseases 7 (suppl. 1): 5113-5122

144. Epstein L G, Sharer L R, Joshi V V et al 1985 Progressive encephalopathy in children with acquired immune deficiency syndrome. Annals of Neurology 17: 488-496

145. Epstein L G, Sharer L R, Oleske J M et al 1986b Neurologic manifestations of human immunodeficiency virus infection in children. Pediatrics 78: 678-687

146. Eraklis A J, Kevij S V, Diamond L K 1967 Hazard of overwhelming infection after splenectomy in childhood. New England Journal of Medicine 276: 1225-1229

147. Escobar J A, Belsey M A, Duenas A et al 1975 Mortality from tuberculous meningitis reduced by steroid therapy. Pediatrics 56: 1050-1055

148. Eskola J, Peltola H, Takala A K 1987 Efficacy of Haemophilus influenzae type B polysaccharide-diphtheria toxoid conjugate vaccine in infancy. New England Journal of Medicine 317: 717-722

149. European Collaborative Study 1992 Risk factors for mother-to-child transmission of HIV 1. Lancet 339: 1007-1012.

150. Fallon R J, Kennedy D H 1981 Treatment and prognosis in tuberculous meningitis. Journal of Infection 3 (suppl. 1): 39-44

151. Feigin R D, Stechenberg B W 1987 Diphtheria. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 1134-1141

152. Feigin R D, McCracken G H Jr, Klein J 0 1992 Diagnosis and management of meningitis. Pediatric Infectious Diseases Journal 11:785-814

153. Feldstein T J, Uden D L, Larson T A 1987 Cefotaxime for treatment of Gram-negative bacterial meningitis in infants and children. Pediatric Infectious Disease Journal 6: 471-475

154. Figueroa J E, Densen P 1991 Infectious diseases associated with complementary deficiencies. Clinical Microbiology Reviews 4:359-395

155. Flaguel B, Walolach D, Vignon-Pennamer M 1989 Late onset reversal reaction in borderline leprosy. Journal of the American Academy of Advanced Dermatology 20: 857-860

156. Foreman S D, Smith E E, Ryan N J et al 1984 Neonatal citrobacter meningitis: pathogenesis of cerebral abscess formation. Annals of Neurology 16: 655-659

157. FradkinJ E, Schoenberger L B, Mills J L et al 1991 Creutzfeldt-Jakob disease in pituitary growth hormone recipients in the United States. Journal of the American Medical Association 265: 880-8 84

158. Fraser D W, Darby C P, Koehler R E 1973 Risk factors in bacterialmeningitis: Charleston County, South Carolina. Journal of Infectious Diseases 127: 271-277

159. Gajdusek D C 1977 Unconventional viruses and the origin and disappearance of Kuru. Science 197: 943-960

160. Gajdusek D C, Vigas V 1959 Clinical pathological and epidemiological study of an acute progressive degenerative disease of the central nervous system among natives of the Eastern Highlands of New Guinea. American Journal of Medicine 26: 442-469

161. Gallo R C 1984 Human T cell leukaemia-lymphoma virus and T cell malignancies in adults. Cancer Surveys 3: 113-159

162. Gallo R C 1987 The AIDS virus. Scientific American 256: 46-56

163. Gessain A, Barin F, Vernant J C 1985 Antibodies to human T lymphotropic virus type 1 in patients with tropical spastic paraparesis. Lancet 2: 407-410

164. Gibbs C J, Toy A, Heffner R et al 1985 Clinical and pathological features of laboratory confirmation of a Creutzfeldt-Jakob disease in a recipient of pituitary derived human growth hormone. New England Journal of Medicine 313: 734-738

165. Girgis N I, Farid Z, Mikhail I A et al 1989 Dexamethasone treatment for bacterial meningitis in children and adults. Pediatric Infectious Disease journal 8: 848-851

166. Glickman L T, Schantz P M 1981 Epidemiology and pathogenesis of zoonotic toxocariasis. Epidemiologic Reviews 3: 230-250

167. Gordeuk V, Thuma P, Brittenham G et al 1992 Effect of iron chelation therapy on recovery from deep coma in children with cerebral malaria [see comments] New England Journal of Medicine 327(21): 1473-1477

168. Granoff D M, Basden M 1980 Haemophilus influenzae infections in Fresno County. California: a prospective study of the effects of age, race, and contact with a case on incidence of disease. Journal of Infectious Diseases 141: 40-46

169. Granoff D M, Squires J E, Munson R S 1983 Siblings of patients with haemophilus meningitis have impaired anticapsular antibody responses to haemophilus vaccine. Journal of Pediatrics 103: 185-191

170. Grau G E, Taylor T E, Molyneux M E et al 1989 Tumor necrosis factor and disease severity in children with falciparum malaria. New England Journal of Medicine 320(24): 1586-1591

171. Green W R, Sweet L K, Pritchard R W 1974 Acute lymphocytic choriomeningitis. Journal of Pediatrics 35: 688-701

172. Greenberg M, Pellitteri 0, Eisenstein D T 1955 Measles encephalitis. 1. Prophylactic effect of gama globulin. Journal of Pediatrics 46:462-467

173. Greenfield S, Sheehe P R, Feldman H A 1971 Meningococcal carriage in a population of normal families. Journal of Infectious Diseases 123: 67-73

174. Greenwood B M 1984 Treatment and prevention of meningococcal disease. Tropical Doctor 14: 61-66

174. Greenwood B M, Bradley A K, Blakeborough I S et al 1984 Meningococcal disease and season in Sub-Saharan Africa. Lancet: 1339-1342

175. Greenwood B M 1987 The epidemiology of acute bacterial meningitis in tropical Africa. In: Williams J D, Burnie J (eds) Bacterial meningitis. Academic Press, London, pp 61-91

176. Grose C, Henle W, Henle G, Feorino P M 1975 Primary Epstein-Barr virus infections in acute neurological diseases. New England Journal of Medicine 292: 392-395

177. Haase J, Christensen P B, Kock K et al 1985 Cerebellar tuberculoma: a rare disease in an industrialized country. Child's Nervous System 1: 295-297

178. Hall W W, Choppin P W 1981 Measles-virus proteins in brain tissue of patients with subacute sclerosing panencephalitis. New England Journal of Medicine 304: 1152-1155

179. Hanshaw J B, Dudgeon J A, Marshall M D 1985b Viral diseases of the fetus and newborn. Saunders, London

180. Hanshaw J B, Dudgeon J A, Marshall W C 1985a Congenital cytomegalovirus. In: Viral diseases of the fetus and newborn, 2nd edn. Saunders, London, pp 92-131

181. Hanshaw J B, Scheiner A P, Moxley A W et al 1976 School failure and deafness after `silent' congenital cytomegalovirus infection. New England Journal of Medicine 295: 468-470

182. Havens P L, Garland J S, Brook M M et al 1989 Trends in mortality in children hospitalized with meningococcal infections 1957-1987. Pediatric Infectious Disease journal 8: 8-10

183. Heyderman R S, Robb S A, Kendall B et al 1992 Does computerized tomography have a role in the evaluation of complicated acute bacterial meningitis? Developments in Medicine and Childhood Neurology 34:870-875.

184. Hirsch M S, Moellering R C, Pope H G et al 1974 Lymphocytic- choreomeningitis-virus infection traced to a pet hamster. New England Journal of Medicine 291: 610-612

185. Ho M, Singh B, Looareesuwan S, Davis T M et al 1991 Clinical correlates of in vitro Plasmodium falciparum cytoadherence. Infectious Immunology 59(3): 873-878

186. Hoffman S L 1986 Treatment of malaria. Clinics in Tropical Medicine and Communicable Diseases 1: 171-224

187. Hoke C H, Nisalak A, Sangawhipa N et al 1988 Protection against Japanese encephalitis by inactivated vaccines. New England Journal of Medicine 319: 608-613

188. Hollander H, Levy J A 1987 Neurological abnormalities and recovery of human immunodeficiency virus from the cerebrospinal fluid. Annals of Internal Medicine 106: 692-695

189. Holliman R E 1988 Toxoplasmosis and the acquired immune deficiency syndrome. Journal of Infection 16: 121-128

190. Hope-Simpson R E 1965 The nature of herpes zoster. A long-term study and a new hypothesis. Proceedings of the Royal Society of Medicine 58: 9-20

191. Houff S A, Major E 0, Katz D et al 1988 Involvement of JC virus- infected mononuclear cells from the bone marrow and spleen in the pathogenesis of progressive multifocal leukoencephalopathy. New England Journal of Medicine 318: 301-305

192. Humphries M 1992. The management of tuberculous meningitis. Thorax 47: 577-581

193. Huntley C C, Costas M C, Lyverly B S 1965 Visceral larva migrant syndrome: clinical characteristics and immunologic studies in 51 patients. Pediatrics 36: 523-563

194. Hutto C, Arvin A, Jacobs R et al 1987 Intrauterine herpes simplex virus infections. Journal of Pediatrics 110: 97-101

195. Idriss Z H, Sinno A, Kronfol N M 1976 Tuberculous meningitis in childhood: forty-three cases. American Journal of Diseases in Children 130:364-367

196. Irving W L, Chang J, Raymond D R et al 1990 Roseola infantum and other syndromes associated with acute HHV6 infection. Archives of Disease in Childhood 65: 1297-1300

197. Ishiguro N, Yamada S, Takahashi T 1990 Meningo-encephalitis associated with HHV 6 related exanthem subitum. Acta Paediatrica Scandinavica 79: 987-989

198. Istre C R, Connor J S, Broome C V 1985 Risk factors for primary invasive Haemophilus influenzae disease: increased risk from day care attendance and school aged household members. Journal of Pediatrics 105:190-195

199. Jacobs R F, Wells T G, Steele R W et al 1985 A prospective randomized comparison of cefotaxime versus ampicillin and chloramphenicol for bacterial meningitis in children. Journal of Pediatrics 107: 129-133

200. Jaffe I P 1982 Tuberculous meningitis in childhood. Lancet 1: 738-739

201. James I I E, Walsh J W, Wilson H D 1980 Prospective randomized study of therapy in cerebrospinal fluid shunt infections. Neurosurgery 7:459-463

202. Job C K et al 1969 Leprous myositis - a histopathological and electron microscopic study. Leprosy Review 40: 9

203. Job C K, Desikan K V 1968 Pathological changes and their distribution in peripheral nerves in lepromatous leprosy. International Journal of Leprosy 36: 257-270

204. Johnson J K, Swerlick R A, Grady K K et al 1993 Cytoadherence of Plasmodium falciparum-infected erythrocytes to microvascular endothelium is regulatable by cytokines and phorbol ester. Journal of Infectious Diseases 167(3): 698-703

205. Johnson R T 1987 The pathogenesis of acute viral encephalitis and postinfectious encephalomyelitis. Journal of Infectious Diseases 155:359-361

206. Jones D 1995 Epidemiology of meningococcal disease in Europe and theUSA. In: Cartwright K (ed.) Meningococcal disease Wiley, Chichester, ch 9

207. Jones D, Mallard R 1993 Age incidence of meningococcal infection in England and Wales. 1984-1991. Journal of Infection 27: 83-88

208. Kahlon J, Chatterjee S, Lakeman F et al 1987 Detection of antibodies to herpes simplex virus in the cerebrospinal fluid of patients with herpes simplex encephalitis. Journal of Infectious Diseases 155: 38

209. Kaneko K, Onodera 0, Miyatake T et al 1990 Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. Neurology 40:1617-1618

210. Kaplan S L, Catlin F I, Weaver T 1984 Onset of hearing loss in children with bacterial meningitis. Pediatrics 73: 575-578

211. Kaplan S L, Feigin R D 1978 The syndrome of inappropriate secretion of antidiuretic hormone in children with bacterial meningitis. Journal of Pediatrics 92: 758-761

212. Kaplan S L, Fishman M A 1987 Supportive therapy for bacterial meningitis. Pediatric Infectious Diseases Journal 6: 670-677

213. Kaplan S L, Smith E 0 B, Wills C et al 1986 Association between preadmission oral antibiotic therapy and cerebrospinal fluid findings and sequelae caused by Haemophilus influenzae type B meningitis. Pediatric Infectious Disease Journal 5: 626-632

214. Katz B Z, Andiman W A, Eastman R et al 1986 Infection with two genotypes of Epstein Barr virus in an infant with AIDS and lymphoma of the central nervous system. Journal of Infectious Diseases 153:601-604

215. Kaufman H H, Catalano L W 1979 Diagnostic brain biopsy: a series of 50 cases and a review. Neurosurgery 4: 129-136

216. Kawasaki T 1967 Acute febrile mucotaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes. Japanese journal of Allergy 16: 178-222

217. Kawo N G, Msengi A E, Swai A B et al 1990 Specificity of hypoglycaemia for cerebral malaria in children [see comments]. Lancet 336(8713): 454-457

218. Kennard C, Swash M 1981 Acute viral encephalitis: its diagnosis and outcome. Brain 104: 129-148

219. Kennedy C R, Duffy S W, Smith R et al 1987 Clinical prediction of outcome in encephalitis. Archives of Disease in Childhood 62:1156-1162

220. Kennedy C R, Robinson R 0, Valman H B et al 1986 A major role for viruses in acute childhood encephalopathy. Lancet: 989-991

221. Khang T Y, Frappell J M, Steel H M et al 1986 Perinatal listeriosis: a report of six cases. British Journal of Obstetrics and Gynaecology 93:1083-1087

222. Kimura H, Aso K, Kuzushima K et al 1992 Relapse of herpes simplex encephalitis in children. Pediatrics 89: 891-894

223. King S M, Gorensek M, Ford Jones E I et al 1986 Fatal varicella zoster infection in a newborn treated with varicella zoster immunoglobulin. Pediatric Infectious Disease journal 5: 588-589

224. Klein J 0, Feigin R D, McCracken G H 1986 Report of the task force on diagnosis and management of meningitis. Journal of Pediatrics 78(S): 959-982

225. Klein N J, Heyderman R S, Levin M 1992 Antibiotic choices for meningitis beyond the neonatal period. Archives of Disease in Childhood 67: 157-161

226. Koenig S, Gendelman, H E, Orsenstein J M et al 1986 Detection of AIDS virus in macrophages in brain tissue from AIDS patients with encephalopathy. Science, 223: 1089-1093

227. Koeze T H, Klingon G H 1964 Acquired toxoplasmosis. Archives of Neurology 11: 191-197

228. Kohl S 1988 Herpes simplex virus encephalitis in children. Pediatric Clinics of North America 35: 465-483

229. Kovanen J, Schauma N K, Valpas J 1986 Banwath's syndrome and Lyme disease in Finland. Scandinavian Journal of Infectious Disease 18:421-424

230. Krambovitis E, Mclllmarray M B, Lock P E et al 1984 Rapid diagnosis of tuberculous meningitis by latex particle agglutination. Lancet 2:1229-1231

231. Kramer M D, Aita J F 1972 Trichinosis with central nervous system involvement. Neurology 22: 485-491

232. Kranski K, Borkowskv W, Bonk S et al 1988 Bacterial infections in human immunodeficiency virus-infected children. Pediatric Infectious Disease journal 7: 323-328

233. Kresky B, Nauheim J S 1967 Rubella retinitis. American Journal of Diseases of Children 113: 305-310

234. Kreth H W, Ter Meulen V, Eckert G 1975 HL-A and subacute sclerosing panencephalitis. Lancet 2: 415-416

235. Kurent J E, Sever J L, Terasaki P 1 1975 HL-A W29 and subacute sclerosing panencephalitis. Lancet 2: 927

236. Kroll J S, Booy R 1996 Haemophilus influenzae: capsule vaccine and capsulation genetics. Molecular Medicine Today 2: 160-165

237. Kwiatkowski D, Hill A V, Sambou I et al 1990 TNF concentration in fatal cerebral, non-fatal cerebral, and uncomplicated Plasmodium falciparum malaria. Lancet 336(8725): 1201-1204

238. La Boccetta A C, Tornay A S 1964 Measles encephalitis: report of 61 cases. American Journal of Diseases in Childhood 107: 247--255

239. Lakeman F D, Koga J, Whitley R J 1987 Detection of antigen to herpes simplex in cerebrospinal fluid from patients with herpes simplex encephalitis. Journal of Infectious Diseases 155: 1172-1178

240. Lambert H P 1987 Problems of standard therapy and their possible solution. In Williams J D, Burnie J (eds) Bacterial meningitis. Academic Press, London, pp 203-209

241. Lauter C B 1980 Herpes simplex encephalitis: a great clinical challenge. Annals of Internal Medicine 93: 696-698

242. Label M H, Freij R J, Syrogiannopoulos G A et al 1988 Dexamethasone therapy for bacterial meningitis: results of two double-blind placebo- controlled trials. New England Journal of Medicine 319: 964-971

243. Lechtenberg R, Vaida G A 1977 Schistosomiasis of the spinal cord. Neurology 27: 55-59

244. Lecour H, Seara A, Miranda A M et al 1984 Treatment of 160 cases of acute bacterial meningitis with cefotaxime. Journal of Antimicrobiology and Chemotherapy 14(S): 195-202

245. Legg N J 1967 Virus antibodies in subacute sclerosing panencephalitis: a study of 22 patients. British Medical Journal 3: 350-352

246. Lennon D, Voss L, Sinclair J et al 1989 An outbreak of meningococcal disease in Auckland, New Zealand Pediatric Infectious Diseases 8: 11-15

247. Lerer R J, Kalavsky S M 1973 Central nervous system disease associated with Mycoplasma pneumoniae infection: report of five cases and review of the literature. Pediatrics 52: 658-668

248. Levin M, Eley B, Louis J et al 1995 Postinfectious purpura fulminans caused by an autoantibody directed against protein. S. Journal of Pediatrics 127: 355-363

249. Levin M, Heyderman R S. 1990 Bacterial meningitis. Advances in Paediatrics 9: 1-19

250. Levin M, Kay J D S, Gould J D et al 1983 Haemorrhagic shock and encephalopathy: a new syndrome with a high mortality in young children.Lancet 2: 64-67

251. Levin M, Pincott J R, Hjelm M et al 1989b Haemorrhagic shock and encephalopathy: clinical, pathologic, and biochemical features. Journal of Pediatrics 114: 194-203

252. Levin D P, Lauter C B, Lerner A M 1978 Simultaneous serum and CSF antibodies in herpes simplex encephalitis. Journal of the American Medical Association 240: 356-360

253. Lewallen S, Taylor T E, Molyneux M E et al 1993 Ocular fundus findings in Malawian children with cerebral malaria. Ophthalmology 100(6): 857-861

254. Lipton S A 1992 Models of neuronal injury in AIDS: another role for the NMDA receptor? Trends in Neuroscience 15: 75-79

255. Lipton S A, Sucher N K, Kaiser P K et al 1991 Synergistic effects of the HIV coat protein and NMDA receptor-mediated neurotoxicity. Neurology 7: 111-118

256. Loft R J, Remington J S 1988 Toxoplasmic encephalitis. Journal of Infectious Diseases 157: 1-6

257. Looareesuwan S, Warrell D A, White N J et al 1983 Do patients with cerebral malaria have cerebral oedema? A computed tomography study. Lancet 1(8322): 434-437

258. MacPherson G, Warrell M J, White N J et al 1985 Human cerebral malaria: a quantitative ultrastructural analysis of parasitised erythrocyte sequestration. American Journal of Pathology 119:385-401

259. Manco Johnson M, Nuus R, Iley N, Moertel C, Jacobson L 1996 LupusAnticoagulant and protein S deficiency in children with post varicella purpura fulminans and thrombosis. Journal of Pediatrics 128:319-323

260. Marcial Rojas R A, Fiol R E 1963 Neurological complications of schistosomiasis: review of the literature and report of two cases of transverse myelitis. Annals of Internal Medicine 59: 215-230

261. Marks W A, Stutman H R, Marks M 1 1986 Cefuroxime versus ampicillin plus chloramphenicol in childhood bacterial meningitis: a multicenter randomized control trial. Journal of Pediatrics 109: 123-130

262. Marshall W C 1983 Infections of the nervous system. In: Brett E M (ed.) Pediatric neurology. Churchill Livingstone, Edinburgh

263. Mascola L, Pelosi R, Blount J H et al 1985 Congenital syphilis revisited. American Journal of Diseases in Children 139: 575-580

264. Masters C L, Richardson E P 1978 Subacute spongiform encephalopathy (Creutzfeldt-Jakob disease): the nature and progression of spongiform change. Brain 101: 333-344

265. McCabe R, Remington J C 1988 Toxoplasmosis, the time has come. New England Journal of Medicine 318: 313-315

266. McCarthy J I, Amer J 1978 Post varicella acute transverse myelitis: a case presentation and review of the literature. Pediatrics 62: 202-204

267. McCracken G H, Freil B J 1987 Perinatal bacterial diseases. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 940-966

267. McCracken G H, Nelson J D, Kaplan S L et al 1987 Consensus report: antimicrobial therapy for bacterial meningitis in infants and children. Pediatric Infectious Diseases Journal 6: 501-505

268. McCracken G H, Kaplan J M 1974 Penicillin treatment for congenital syphilis. Journal of the American Medical Association 228: 855-858

269. McCracken G H, Mize S G 1976 A controlled study of intrathecal antibiotic therapy in Gram negative enteric meningitis of infancy. Journal of Pediatrics 89: 66-72

270. McCracken G H, Mize S G, Threlkeld N 1980 Intraventricular gentamicin therapy in gram-negative bacillary meningitis of infancy. Lancet: 787-791

271. McCracken G H, Threlkeld N, Mize S B et al 1984 Moxalactam therapy for neonatal meningitis due to gram negative enteric bacilli: a prospective controlled evaluation. Journal of the American Medical Association 252: 1427-1432

272. McDonald J C, Moore D L 1988 Mycoplasma hominis meningitis in a premature infant. Pediatric Infectious Disease journal 7: 795-798

273. McGee Z A, Kaiser A B, Rubens C et al 1977 Emergence of chloramphenicol resistance during chloramphenicol therapy of gram negative bacillary meningitis. In: Proceedings and abstracts of the 17th interscience conference on antimicrobial agents and chemotherapy. New York. American Society for Microbiology, Washington

274. McGrath E, Rosenbloom L 1980 Use of isoprinosine in subacute sclerosing panencephalitis. Archives of Disease in Childhood 55:829-830

275. McKendrick G D W 1979 Diagnosis of herpes simplex encephalitis. Lancet 2: 1181-1182

276. McLaurin R L, Frame P T 1987 Treatment of infections of cerbrospinal fluid shunts. Reviews of Infectious Diseases 9: 59 5-602

277. McLean D M, Larke R P B, Cobb C et al 1967 Mumps and enteroviral meningitis in Toronto 1966. Canadian Medical Association journal 96:1355-1361

278. McIntyre A 1971 Hydatid disease in children in South Australia. Medical Journal of Australia 1: 1064-1065

279. Meirovitch J, Kitai-Cohen Y, Keren G et al 1987 Cerebrospinal fluid shunt infections in children. Pediatric Infectious Disease journal 6:921-924

280. Meissner H C, Gellis S E, Milliken J 1982 Lyme disease first observed to be aseptic meningitis. American Journal of Diseases in Children 136:465-467

281. Meningococcal Disease Surveillance Group 1976 Analysis of endemic meningococcal disease by serogroup and evaluation of chemoprophylaxis. Journal of Infectious Diseases 134: 201-204

282. Mertsola J, Kennedy W A, Wagner D C et al 1991 Endotoxin concentrations in cerebrospinal fluid correlated with clinical severityand neurological outcome of Haemophilus influenzae type b meningitis. American Journal of Diseases in Children 145: 1079-1103

283. Merz P A, Rohwer R G, Kascsak R 1984 Infection-specific particle from the unconventional slow virus diseases. Science 225: 437-440

284. Metz H, Gregoriou M, Sandifer P 1964 Subacute sclerosing panencephalitis. Archives of Disease in Childhood 39: 554-557

285. Meyer H M, Johnson R T, Crawford I P et al 1960 Central nervous system syndromes of viral etiology: a study of 713 cases. American Journal of Medicine 334-346

286. Meyer N, Rosenbaum V, Schmidt B et al 1991 Search for a putative scrapie genome in purified prion fractions reveals a paucity of nucleic acids. Journal of General Virology 72: 37-49

287. Meyers W M 1992 Leprosy. In: Feigin R D, Cherry J D (eds) Textbook of pediatric infectious diseases, 3rd edn. Saunders, Philadelphia, pp 1149-1166

288. Michaels J, Sharer L R, Epstein L G 1988 Human immunodeficiency virus type 1 (HIV 1) infection of the nervous system: A review. Immunodeficiency Review 1: 71-104

289. Miko T L, Maitre C L, Kinfu Y 1993 Damage and exaggeration of peripheral nerves in advanced treated leprosy. Lancet 342: 521-525

290. Miller J D, Ross C A C 1968 Encephalitis: a four year survey. Lancet: 1121-1126

291. Mintz M, Epstein L G, Koeningsberger M R 1989a Neurological manifestations of acquired immunodeficiency syndrome in children. International Pediatrics 4: 161-171

292. Mintz M, Rapaport R, Oleske J et al 1989b Elevated serum levels of tumor necrosis factor are associated with progressive encephalopathy in children with acquired immunodeficiency syndrome. American Journal of Diseases in Children 143: 771-774

293. Mitchell W G, Crawford T 0 1988 Intraparenchymal cerebral cysticercosis in children: diagnosis and treatment. Pediatrics 82: 76-82

294. Modlin J F, Brandling-Bennett D, Witte J J et al 1975 A review of five years' experience wth rubella vaccine in the United States. Pediatrics 55: 20-29

295. Modlin J F, Halsey N A, Eddins D L et al 1979 Epidemiology of subacute sclerosing panencephalitis. Journal of Pediatrics 94: 231-236

296. Modlin J F 1990 In: Mandell G L, Douglas R G, Bennett J E (eds) Principles and practice of infectious diseases, 3rd edn. Churchill Livingstone, Edinburgh, pp 1359-1367

297. Molyneux M E, Taylor T E, Wirima J J et al 1989 Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children [see comments]. Q Journal of Medcine 71 (265): 441-459

298. Monard-Krohn G H 1923 The neurological aspects of leprosy. Chicago Medical Book, Chicago

299. Monath T P 1988 Japanese encephalitis: a plaque of the Orient. New England Journal of Medicine 319: 641-643

300. Moodley M, Moosa A 1989 Treatment of neurocysticercosis: is praziquantel the new hope? Lancet: 262-263

301. Moxon E R, Zwahlen A, Rubin L G et al 1984 Pathogenesis of meningitis: experimental studies on the molecular basis of Haemophilus influenzae. Infection 12(8): 523-527

302. Muhlemann M F, Wright D J 1987 Emerging pattern of Lyme disease in the United Kingdom and Irish Republic. Lancet: 260-262

303. Mulder C J J, Van Alphen L, Zanen H C 1984 Neonatal meningitis caused by Escherichia coli in the Netherlands. Journal of Infectious Diseases 150: 935-940

304. Murphy E L 1993 HTLV II related disease. Lancet 341: 888

305. Mustafa M M, Ramilo 0, Syrogiannopoulos G A et al 1989 Induction of meningeal inflammation by outer membrane vesicles of Haemophilus influenzae type b. Journal of Infectious Diseases 159: 917-922

306. Myint T T 1980 Tuberculous meningitis and BCG vaccination in Burmese children. Journal of Tropical Pediatrics 26: 227-231

307. SFSF'`idel S, Levin M, Habibi P. 1995 Treatment of meningococcal disease.In: Cartwright K (ed.) Meningococcal disease. Wiley, Chichester, ch 9

308. Nakamura K, Hasler T, Morehead K et al 1992 Plasmodium falciparum- infected erythrocyte receptor(s) for CD36 and thrombospondin are restricted to knobs on the erythrocyte surface. Journal of Histochemistry and Cytochemistry 40(9): 1419-1422

309. Newton C R, Kirkham F J, Winstanley P A et al 1991 Intracranial pressure in African children with cerebral malaria [see comments]. Lancet 337(8741): 573-576

310. Nicolaidou P, Iacovidou N, Youroukos S et al 1993 Relapse of herpes simplex encephalitis after acyclovir therapy. European Journal of Pediatrics 152: 737-738

311. Nielsen H 1983 Cerebral abscess in children. Neuropediatrics 14: 76-80

312. Niemoller V M, Tauber M G 1989 Brain edema and increased intracranial pressure in the pathophysiology of bacterial meningitis. European Journal of Clinical and Microbiological Infectious Diseases 8: 109-117

313. Nihill M R, Feigin R D, Gruber R et al 1987 Kawasaki disease. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 2137-2165

314. Noah N D 1987 Eidemiology of bacterial meningitis. In: Williams J D, Burnie J (eds) Bacterial meningitis. Academic Press, London, pp 93-115

315. Noorden S K, Lopez Bravo L, Sundaresan T K 1992 Estimated number of leprosy cases in the world. Bulletin of the World Health Organization 70: 7-10

316. Nottidge V A 1983 Pneumococcal meningitis in sickle cell disease in childhood. American Journal of Disease in Childhood 137: 29-31

317. Ockenhouse C F, Tandon N N, Magowan C et al 1989 Identification of a platelet membrane glycoprotein as a falciparum malaria sequestration receptor [see comments]. Science 243(4897): 1469-1471

318. Ockenhouse C F, Tegoshi T, Maeno Y et al 1992 Human vascular endothelial cell adhesion receptors for Plasmodium falciparum- infected erythrocytes: roles for endothelial leukocyte adhesion molecule 1 and vascular cell adhesion molecule 1. Journal of Experimental Medicine 176(4): 1183-1189

319. Odio C M, Faingezicht I, Salas J L 1986 Cefotaxime versus conventional therapy for the treatment of bacterial meningitis of infants and children. Pediatric Infectious Disease journal 5: 402-407

320. Odio C M, Faingezicht I, Paris M et al 1991 The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. New England Journal of Medicine 324:1525-1531

321. Offenbacher H, Fazekas F, Schmidt R et al 1991 MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. Journal of Neurology 238: 340-344

322. Ogel J W, Toltzis P, Parker W D et al 1989 Oral ribavirin therapy for subacute sclerosing panencephalitis. Journal of Infectious Diseases 159(4): 748-750 Oh S 1968 Paragonimus meningitis. Journal of the Neurological Sciences 6:419-433

323. Osterholm M T, Pierson L M, White K E et al 1987 The risk of subsequent tranmission of Hemophilus influenzae type B disease among children in day care. New England Journal of Medicine 316:5-10

324. Pahwa S 1988 Human immunodeficiency virus infection in children: nature of immunodeficiency, clinical spectrum and management. Pediatric Infectious Disease journal 7: 561-571

325. Pampiglione G 1964 Polymyographic studies of some involuntary movement in subacute sclerosing panencephalitis. Archives of Disease in Childhood 39: 558-563

326. Paredes A, Wong P, Mason E 0 et al 1977 Nosocomial transmission of group B streptococci in a nursery. Pediatrics 59: 679-682

327. arker P, Puck J, Fernandez F 1981 Cerebral infarction associated with Mycoplasma pneumoniae. Pediatrics 67: 373-375

328. Paryani S G, Arvin A M 1986 Intrauterine infection with varicella zoster virus after maternal varicella. New England Journal of Medicine 314:1542-1546

329. Pass R F, Stagno S, Myers G J et al 1980 Outcome of symptomatic congenital cytomegalovirus infection: results of long-term longitudinal follow-up. Pediatrics 66: 758-762

330. Patrick C C, Kaplan S L 1988 Current concepts in the pathogenesis and management of brain abscesses in children. Pediatric Clinics of North America 35: 625-636

331. Paul F M 1961 Tuberculosis in BCG vaccinated children in Singapore. Archives of Disease in Childhood 36: 530-536

332. Peckham C S 1972 A clinical and laboratory study of children exposed in utero to maternal rubella. Archives of Disease in Childhood 47: 571-577

333. Peltola H, Anttila M, Renkonen 0 1989 Randomized comparison of chloramphenicol, ampicillin, cefotaxime and ceftriaxone for childhood bacterial meningitis. Lancet 1: 1281-1286

334. Pearson J M H, Ross W X 1975 Nerve involvement in leprosy - pathology, differential diagnosis and principles of management. Leprosy Review 46:199-207

335. Pfaltzgraff R E, Bryceson A 1985 Clinical leprosy. In: Hastings R C (ed.) Leprosy. Churchill Livingstone, Edinburgh Phillips R E, Solomon T 1990 Cerebral malaria in children. Lancet 336(8727): 1355-1360

336. Phillips R E, Warrell D A, White N J et al 1985 Intravenous quinidine for the treatment of severe falciparum malaria. Clinical and pharmacokinetic studies. New England Journal of Medicine 312(20): 1273-1278

337. Pike M G, Wong P K H, Bencivengo R et al 1990 Electrophysiological studies, computed tomography and neurological outcome in acute bacterial meningitis. Journal of Pediatrics 116: 703-706

338. Pippard M J, Dalgleish A, Gibson P et al 1986 Acquired immunodeficiency with disseminated cryptococcosis. Archives of Disease in Childhood 61: 289-291

339. Pizzo P A, Butler K, Balis F 1990 Dideoxycytidine alone and in an alternating schedule with zidovudine in children with symptomatic human immunodeficiency virus infection. Journal of Pediatrics 117:799-808

340. Pizzo P A, Eddy J, Falloon J et al 1988 Effect of continuous intravenous infusion of zidovudine (AZT) in children with symptomatic HIV infection. New England Journal of Medicine 319: 889-896

341. Ponnighaus J M, Fine P E M, Sternae J A C et al 1992 Efficacy of BCG vaccine against leprosy and tuberculosis in Northern Malawi. Lancet 399:636-639

342. Porterfield J S 1987 Alphaviruses, flaviviruses and bunyaviridae. In: Zuckerman A J, Banatvala J E, Pattison J R (eds) Principles and practice of clinical virology. Wiley, Chichester, pp 419-431

343. Portnoy J M, Olson L 1985 Normal cerebrospinal fluid values in children: another look. Pediatrics 76: 485-487

344. Powderly W G, Saag M S, Cloud G A 1992 A controled trial of fluconazole or amphoteritic B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. New England Journal of Medicine 326: 793-798

345. Powell K R, Sugarman L I, Eskenazi A E et al 1990 Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. Journal of Pediatrics 117: 515-522

346. Preblud S R 1981 Age-specific attack rates of varicella complications. Pediatrics 68: 14-17

347. Prober C G, Hensleigh P A, Boucher F D et al 1988 Use of routine viral cultures at delivery to identify neonates exposed to herpes simplex virus. New England Journal of Medicine 318: 887-891

348. Prusiner S B 1982 Novel proteinaceous infectious particles cause scrapie. Science 216: 136-144

349. Prusiner S B 1987 Human slow infections: prion diseases. In: Zuckerman A J, Banatvala J E, Pattison J R (eds) Principles and practice of clinical virology. Wiley, Chichester, pp 545-565

350. Prusiner S B 1991 Molecular biology of prion diseases. Science 252:1515-1522

351. Pullan C R, Noble C T Scott D J et al 1976 Atypical measles infection in leukaemic children on immunosuppressive treatment. British Medical journal 1: 1562-1565

352. Quagliarello V, Scheld W M 1992 Bacterial meningitis: pathogenesis, pathophysiology and progress. New England Journal of Medicine 327:864-872

353. Radhakrishnan V V, Mathai A, Sehgal S 1990 Correlation between culture of Mycobacterium tuberculosis and IgG antibody to Mycobacterium tuberculosis antigen-5 in the cerebrospinal fluid of patients with tuberculous meningitis. Journal of Infection 21:271-277

354. Radhakrishnan V V, Mathai A 1991 Detection of Mycobacterium tuberculosis antigen-5 in cerebrospinal fluid by inhibition ELISA and its diagnostic potential in tuberculous meningitis. Journal of Infectious Diseases 163: 650-652

355. Rahal J, Simberkoff M S 1979 Bactericidal and bacteriostatic action of chloramphenicol against meningeal pathogens. Antimicrobial Agents and Chemotherapy 16: 13-18

356. Ramilo 0, Saez-Llorens X, Mertsola J et al 1990 Tumor necrosis factor alpha/cachectin and interleukin 1 beta initiates meningeal inflammation. Journal of Experimental Medicine 172: 497-507

357. Raphael S A, Price M L, Lishner H W et al 1991 Inflammatory demyelinating polyneuropathy in a child with symptomatic human immunodeficiency virus infection. Journal of Pediatrics 118: 242-245

358. Rawley A H, Shulman S T 1987 The search for the etiology of Kawasaki disease. Pediatric Infectious Disease journal 6: 506-508

359. Rea T H, Levan N E 1977 Current concepts in the immunology of leprosy. Archives of Dermatology 113: 345

360. Reik L, Steere A C, Bartenhagen N H, Sharpe R E et al 1979 Neurologic abnormalities of Lyme disease. Medicine 58: 281-294

361. Resnick L, Berger J R, Shapshak P et al 1988 Early penetration of blood- brain-barrier by HIV. Neurology 38: 9-14

362. Richardson E P 1961 Progressive multifocal leukoencephalopathy. New England Journal of Medicine 265: 815-823

363. Richardson E P 1988 Progressive multifocal leukoencephalopathy 30 years later. New England Journal of Medicine 318: 315-317

364. Ridley D S, Jopling W H 1966 Classification of leprosy according to immunity. International Journal of Leprosy 31: 255

365. Robb R M, Watters G V 1970 Ophthalmic manifestations of subacute sclerosing panencephalitis. Archives of Ophthalmology 83:426-435

366. Roberts R B, Romankiewicz J A 1986 Bacterial meningitis in adults. In: Kass E H, Platt R (eds) Current therapy in infectious disease, vol 2. Mosby, London, pp 205-212

367. Rodriguez W J, Puig J R, Khan W N 1986 Ceftazidime versus standard therapy for pediatric meningitis: therapeutic, pharmacologic and epidimiologic observations. Pediatric Infectious Disease journal 5:408-415

368. Roman G C 1987 Retrovirus-associated myelopathies. Archives of Neurology 44: 649-663

369. Roman G C, Spencer P S, Schoenber B S 1985 Tropical myeloneuropathies: the hidden endemias. Neurology 35: 1158-1170

370. Ronne T, Berthelsen L, Buhl L H et al 1993 Comparative studies on pharyngeal carriage of Neisseria meningitides during a localized outbreak of serogroup C meningococcal disease. Scandinavian Journal of Infectious Diseases 25: 331-339

371. Rosman N P, Peterson D B, Kaye E M et al 1985 Seizures in bacterial meningitis, prevalence, patterns, pathogenesis and prognosis. Pediatric Neurology 1: 278-285

372. Rouse D J, Goldenberg R L, Cliver S P et al 1994 Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: a decision analysis. Obstetrics and Gynecology 83(4): 483-494

373. Saez-Llorens X, Romilo 0, Mustafa M M et al 1990a Molecular pathophysiology of bacterial meningitis: Current concepts and therapeutic implications. Journal of Pediatrics 116: 671-684

374. Saez-Llorens X, Romilo 0, Mustafa M M et al 1990b Pentoxifylline modulates meningeal inflammation in experimental bacterial meningitis. Antimicrobial Agents in Chemotherapy 34: 837-843

375. Saez-Llorens X, Jafari H S, Severien S et al 1991 Enhanced attenuation of meningeal inflammation and brain edema by concomitant administration of anti-CD 18 monoclonal antibodies and dexamethasone in experimental Haemophilus meningitis. Journal of Clinical Investigation 88: 2003-2011

376. Sarff L D, McCracken G H, Schiffner M S 1975 Epidemiology of Escherichia coli Kl in healthy and diseased newborns. Lancet 1:1099-1104

377. Saukkonen K, Sande S, Cioffe C et al 1990 The role of cytokines in the generation of inflammation and tissue damage in experimental gram-positive meningitis. Journal of Experimental Medicine 171:439-448

378. Schauseil-Zipf U, Harden A, Hoare R et al 1982 Early diagnosis of Herpes simplex encephalitis in childhood. European Journal of Pediatrics 138: 154-161

379. Schlech W F, Lavigne P M, Botolossi R A 1983 Epidemic listeriosis: evidence for tranmission by food. New England Journal of Medicine 308:203-206

380. Schlech W F, Ward J I, Band J D 1985 Bacterial meningitis in the United States 1978 through 1981: the National Bacterial Meningitis Surveillance Study. Journal of the American Medical Association 253:1749-1754

381. Schoeman J F, Leroux D, Bezuidenhoot P B et al 1985 Intracranial pressure monitoring in tuberculous meningitis: clinical and computerized tomographic correlation. Developmental Medicine and Child Neurology 27: 644-653

382. Scott G, Hutto C, Majuch R W et al 1989 Survival in children with perinatally acquired human immunodeficiency virus type infection. New England Journal of Medicine 321: 1791-1796

383. Sell S H W 1983 Long term sequelae of bacterial meningitis in children. Pediatric Infectious Diseases 2: 90-93

384. Sells C J, Carpenter R L, Ray G C 1975 Sequelae of central nervous system enterovirus infections. New England Journal of Medicine 293:1-4

385. Selmaj K W, Raine C S 1988 T N F mediates myelin and oligodendrocyte damage in vitro. Annals of Neurology 23: 339-346

386. Shankar P, Manjunath N, Mohan K K et al 1991 Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. Lancet 337:5-7

387. Shannon K M, Ammann A J 1985 Acquired immune deficiency syndrome in childhood. Journal of Pediatrics 106: 332-342

388. Shao J, Brubaker B, Levin A et al 1994 Population based study of HIV -1 infection in 4086 subjects in northwest Tanzania. Journal of AIDS 7: 397-402

389. Sharer L R, Epstein L G, Cho E-S et al 1986 Pathologic features of AIDS encephalopathy in children: evidence for LAV: HTLV III infection of brain. Human Pathology 17: 271-284

390. Shenep J L, Flynn P 1986 Infections associated with long term intravascular and cerebrospinal fluid shunt catheters. Advances in Pediatric Infectious Diseases 1: 145-162

391. Sherman F E, Michaels R H, Kenny F M 1965 Acute encephalopathy (encephalitis) complicating rubella. Journal of the American Medical Association 192: 675-681

392. Shwe T, Myint P T, Myint W et al 1989 Clinical studies on treatment of cerebral malaria with artemether and mefloquine. Transcripitions of the Royal Society of Tropical Medicine and Hygiene 83(4)

393. Silverberg R, Brenner T, Abramsky 0 1979 Inosiplex in the treatment of subacute sclerosing panencephalitis. Archives of Neurology 36:374-475

394. Sippel J E, Hider P A, Controni G et al 1984 Use of the direct latex agglutination test for detection ofHaemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis antigens in cerebrospinal fluid from meningitis patients. Journal of Clinical Microbiology 20:884-886

395. Smith A 1 1987 Antibiotic resistance in bacteria causing meningitis. In: Williams J D, Burnie J (eds) Bacterial meningitis. Academic Press, London, pp 117-134

396. Smith A L 1975 Tuberculous meningitis in childhood. Medical journal of Australia 1: 57-60

397. Smith W C S 1992 The epidemiology of disability in leprosy including risk factors. Leprosy Review: 63 (suppl): 23-30

398. Smyth D, Tripp J H, Brett E M et al 1976 Atypical measles encephalitis in leukaemic children in remission. Lancet 1: 574-575

399. Seanjaard L, Bol P, Zanen H C 1986 Non-neonatal meningitis due toless common bacterial pathogens, The Netherlands, 1975-1983. Journal of Hygiene 97: 219-228

400. Spencer J A D 1987 Perinatal listeriosis. British Medical journal 295:349-351

401. Stagno S, Pass R F, Dworsky M E et al 1982 Congenital cytomegalovirus infection: the relative importance of primary and recurrent maternal infection. New England Journal of Medicine 306: 945-949

402. Starke J R 1988 Modern approach to the diagnosis and treatment of tuberculosis in children. Pediatric Clinics of North America 35: 441-464

403. Steele R W, McConnell J R, Jacobs R F et al 1985 Recurrent bacterial meningitis: coronal thin section cranial computed tomography to delineate anatomic defects. Pediatrics 76: 750-753

404. Steere A C, Grodzicki R L, Kornblatt A N et al 1983a The spirochetal etiology of Lyme disease. New England Journal of Medicine 308:733-740

405. Steere A C, Malawista S E, Snydman D R 1977 Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis and Rheumatology 20: 7-17

406. Steere A C, Pachner A R, Malawista S E 1983b Neurologic abnormalities of Lyme disease: successful treatment with high dose intravenous penicillin. Annals of Internal Medicine 99: 767-772

407. Stevens D L, Everett E D 1978 Sequential computerized axial tomography in tuberculous meningitis. Journal of the American Medical Association 239: 642-643

408. Sugimoto T, Sakawa Y, Koboyashi Y 1985 Early diagnosis of herpes simplex virus encephalitis in childhood by the enzyme-linked immunosorbent assay. Acta Neurologica Scandinavica 71: 359-366

409. Sunukawa K, Akita H, Iwata S et al 1984 The influence of cefotaxime on intestinal flora and bleeding diathesis in infants and neonates compared with other beta-lactams. Journal of Microbiology and Chemotherapy 14(S): 317-324

410. Swartz M N 1981 Intraventricular use of aminoglycosides in the treatment of gram-negative bacillary meningitis: conflicting views. Journal of Infectious Diseases 143: 293-296

411. Swedish Study Group 1982 Cefuroxime versus ampicillin and chloramphenicol for the treatment of bacterial meningitis. Lancet 1:295-298

412. Talan D A, Hoffman J R, Yoshikawa T T et al 1988 Role of empiric antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. Review of Infectious Diseases 10: 365-376

413. Tauber M G, Sande M A 1984 Pathogenesis of bacterial meningitis: contributions by experimental models in rabbits. Infection 12(S): 53-58

414. Taylor H G, Michaels R H, Mazur P M et al 1984 Intellectual, neuropsychological and achievement outcomes in children six to eight years after recovery from Haemophilus influenzae meningitis. Pediatrics 74:198-205

415. Taylor T E, Wills B A, Kazembe P et al 1993 Rapid coma resolution with artemether in Malawian children with cerebral malaria. Lancet 341(8846):661-662

416. Tejani A, Dobias B, Sambursky J 1982 Long term prognosis after H. influenzae meningitis: prospective evaluation. Developmental Medicine and Child Neurology 24: 338-343

417. Tejani A, Mahadevan R, Dobias B 1981 Occurrence of HLA types in H. Influenzae type B disease. Tissue Antigens 17: 205-211

418. Townsend J J, Baringer J R, Wolinsky J S et al 1975 Progressive rubella panencephalitis: late onset after congenital rubella. New England Journal of Medicine 292: 990-993

419. Trollfors B, Claesson B A, Strangent K et al 1987 Haemophilus influenzae meningitis in Sweden 1981-1983. Archives of Disease in Childhood 62: 1220-1223

420. Tuomanen E, Liu H, Hengstler B et al 1985 The initiation of meningeal inflammation by components of the pneumococcal cell wall. Journal of Infectious Diseases 151: 859-868

421. Tuomanen E, Saukkonen K, Sande S et al 1989 Reduction of inflammation, tissue damage, and mortality in bacterial meningitis in rabbits treated with monoclonal antibodies against adhesion- promoting receptors of leukocytes. Journal of Experimental Medicine 170:959-969

422. Tureen j H, Dworkin R J, Kennedy S L et al 1990 Loss of cerebrovascular autoregulation in experimental meningitis in rabbits. Journal of Clinical Investigation 85: 577-581

423. Tureen J H, Tauber M G, Sande M A 1991 Effect of indomethacin on the pathophysiology of experimental meningitis in rabbits. Journal of Infectious Diseases 163: 647-649

424. Tureen J H, Tauber M G, Sande M A 1992 Effect of hydration on cerebral blood flow and cerebrospinal fluid lactic acidosis in rabbits with experimental meningitis. Journal of Infectious Diseases 89:947-953

425. Turk D C 1965 Distribution of Hemophilus influenzae in healthy communities. In: Turk D C, May J R (eds) Hemophilus influenzae: its clinical importance. English University Press, London

426. Turner J A 1987 Cestodes. In: Cherry J D, Feigin R J (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 2110-2124

427. Udani P M, Parekh U C, Dastur D K 1971 Neurological and related syndromes in CNS tuberculosis: clinical features and pathogenesis. Journal of Neurological Science 14: 341-357

428. Upton A, Gumpert J 1970 Electroencephalography in herpes simplex encephalitis. Lancet 1: 650-652

429. Valmari P, Peltola H, Ruuskanen 0 et al 1987 Childhood bacterial meningitis - initial symptoms and signs related to age, and reasons for consulting a physician. European Journal of Pediatrics 146:515-518

430. Veterinary Public Health notes 1975 Mosquitoes carry Hansen's disease. Centers for Disease Control. Public Health Service. US Dept HEW 90: 183

431. Visudhiphan P, Chiemchanya S 1989. Tuberculous meningitis in children: Treatment with isoniazid and rifampicin for twelve months. Journal of Pediatrics 114: 875-879

432. von Asmuth E J U, Dentener M A, Bazil V et al 1993 Anti-CD 14 antibodies reduce responses of cultured endothelial cells to endotoxin. Immunology 80: 78-83

433. von Voorhis W C, Kaplan G, Saron E N et al 1982 The cutaneous infiltrates of leprosy. Cellular characteristics and the predominant T -cell phenotypes. New England Journal of Medicine 307:1593-1597

434. Waage A, Halstensen A, Shalaby R et al 1989 Local production of Tumor necrosis factor alpha interleukin 1 and interleukin 6 in meningococcal meningitis: relation to the inflammatory response. Journal of Experimental Medicine 170: 1859-1867

435. Waitkins S A 1985 An update on leptospirosis. British Medical journal 290:1502-1503

436. Wallach D, Cottenot F, Bach M 1982 Imbalance in T cell subpopulations in lepromatous leprosy. International Journal of Leprosy 50: 282-290

437. Walters M F, Rees R J, Sunderland 1 1967 Chemotherapeutic trials in leprosy. International Journal of Leprosy 35: 311

438. Wang D, Bortolussi R 1981 Acute viral infections of the central nervous system in children: an eight year review. Canadian Medical Association Journal 125: 585-589

439. Ward J I, Fraser D W, Baraff L J 1979 Hemophilus influenzae meningitis: a national study of secondary spread in household contacts. New England Journal of Medicine 19: 122-126

440. Warrell D A, Looareesuwan S, Warrell M J 1983 Dexamethasone proves deleterious in cerebral malaria. New England Journal of Medicine 306:313-319

441. Warrell D A, Warrell M J 1988 Human rabies and its prevention: an overview. Review of Infectious Diseases 10: S726-S731

442. Warrell D A 1989 Cerebral malaria [editorial]. Q Journal of Medicine 71(265): 369-371

443. Wasiewski W W, Fishman M A 1988 Herpes simplex encephalitis: the brain biopsy controversy. Journal of Pediatrics 113: 575-578

444. Watt G, Zaraspe G, Bautista S et al 1988 Rapid diagnosis of tuberculous meningitis by using an enzyme-linked immunosorbent assay to detect mycobacterial antigen and antibody in cerebrospinal fluid. Journal of Infectious Diseases 158: 681-686

445. Weil H L, Itabashi H H, Cremer N E et al 1975 Chronic progressive panencephalitis due to rubella virus simulating subacute sclerosing panencephalitis. New England Journal of Medicine 292: 994-998

446. Weiss J, Elsbach P, Shu C et al 1992 Human bactericidal/permeabilityincreasing protein and a recombinant NH2-terminal fragment cause killing of serum resistant gram-negative bacteria in whole blood and inhibit tumor necrosis factor release induced by the bacteria. Journal of Clinical Investigation 90: 1122-1130

447. Weissmann C 1991 A `unified theory' of prion propagation. Nature 353:679-683

448. White N J, Warrell D A, Looareesuwan S et al 1985 Pathophysiological and prognostic significance of cerebrospinal fluid lactate in cerebral malaria. Lancet 1: 776-778

449. White N J, Krishna S, Looareesuwan S 1992 Encephalitis, not cerebral malaria, is likely cause of coma with negative blood smears [letter]. Journal of Infectious Diseases 166(5): 1195-1196

450. White N J, Looareesuwan S, Warrell D A et al 1983 Quinine loading dose in cerebral malaria. American Journal of Tropical Medicine and Hygiene 32(1): 1-5

450. White N J, Warrell D A, Chanthavanich P et al 1983 Severe hypoglycemia and hyperinsulinemia in falciparum malaria. New England Journal of Medicine 309(2): 61-66

451. Whitley R j, Nahmias A J, Visintine ARM 1983 Neonatal herpes simplex infection: follow-up evaluation of vidarabine therapy. Pediatrics 72:778-785

452. Whitley R j, Nahmias A J, Visintine ARM et al 1980 The natural history of herpes simplex virus infection of mother and newborn. Pediatrics 66:489-494

453. Whitley R, Alford C, Hirsch M S et al 1986 Vidarabine versus acyclovir in herpes simplex encephalitis. New England Journal of Medicine 314:144-149

454. Wiley A C, Schrier R D, Nelson J A et al 1986 Cellular localization of human immunodeficiency virus infection within the brains of acquired immunodeficiency syndrome patients. Proceedings of the National Academy of Science USA 83: 7089-7093

455. Wilfert C M, Thompson R J, Sunder J R 1981 Longitudinal assessment of children with enteroviral meningitis during the first three months of life. Pediatrics 67: 811-815

456. Will R G, Ironside J W, Zeidler M et al 1996 A new variant of Creutzfeldt- Jakob disease in the UK. Lancet 347: 921-925

457. Wilson C B, Remington J G, Stagno S S et al 1980 Development of adverse sequelae in children born with subclinical congenital toxoplasma infection. Pediatrics 66: 767-774

458. Wispelwey B, Hansen E J, Scheld W M 1989 Haemophilus influenzae outer-membrane vesicle-induced blood-brain barrier permeability during experimental meningitis. Infection and Immunology 57:2559-2562

459. Wispelwey B, Lesse A J, Hansen E J et al 1988 Haemophilus influenzae lipopolysaccharide-induced blood-brain barrier permeability during experimental meningitis in the rat. Journal of Clinical Investigation 82:1339-1346

460. Witrak B J, Ellis G T 1985 Intracranial tuberculosis: manifestations on computerized tomography. Southern Medical Journal 78: 386-392

461. Winner M 1987 Trypanosomiasis. In: Feigin R D, Cherry J D (eds) Pediatric infectious diseases, 2nd edn. Saunders, Philadelphia, pp 2079-2087

462. Wolf S M 1973 The ocular manifestations of congenital rubella. Journal of Pediatric Ophthalmology 10: 107-141

463. Wolinsky J S, Berg B 0, Maitland C J 1976 Progressive rubella panencephalitis. Archives of Neurology 33: 722-723

464. Wong M, Kaplan S, Dunkle L M et al 1977 Leptospirosis: a childhood disease. Journal of Pediatrics 90: 525-537

465. Wong V, Yeung C Y 1987 Acute viral encephalitis in children. Australian Paediatric journal 23: 339-342

466. Wood M, Anderson M 1988 Neurological infections. Saunders, London, pp 135-168

467. Word B M, Klein J O 1988 Current therapy of bacterial sepsis and meningitis in infants and children: a poll of directors of programs in pediatric infectious diseases. Pediatric Infectious Disease journal 7:267-270

468. World Health Organization 1993 Veterinary Public Health Unit. World Survey of Rabies 27. World Health Organization, Geneva

469. World Health Organization Malaria Action Program 1986 Severe and complicated malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 80: 1-50

470. Wright P F, Kaiser A B, Bowman C M et al 1981 Pharmacokinetics a .d efficacy of an aminoglycoside administered into the cerebral ventricles in neonates: implications for further evaluation of this route of therapy in meningitis. Journal of Infectious Diseases 143: 141-147

471. Wright P W, Avery W G, Ardill W D et al 1993 Initial clinical assessment of the comatose patient: cerebral malaria vs. meningitis. Pediatric Infectious Disease Journal 12(1): 37-41

472. Yamamura M, Uyemura K, Deans R J et al 1991 Defining protective responses to pathogens: cytokine profiles in leprosy lesions. Science 254:277-279

473. Yii C 1976 Clinical observations on eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis in Taiwan. American Journal of Tropical Medicine and Hygiene 25:233-249

474. Zucker J R, Campbell C C 1993 Malaria: principles of prevention and treatment. Infectious Diseases Clinics of North America 7(3): 547-567

475. Zuger A, Lowy F D 1996 Tuberculosis of the brain, meninges, and spinal cord. In: Rom W N, Garay S (eds) Tuberculosis. Little, Brown, Boston, 541-556

Source:[476]

476. edited by Edward M. Brett. Paediatric neurology. New York: Churchill Livingstone, 1997. isbn:044305200X.

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