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Cao X, Li W, Xu Z, Li G, Wen Z, Meng Q, Li P, Yu Z, Chen Z, Zheng J. Loratadine Derivative Lo-7: A Weapon against Drug-Resistant Enterococcus and Streptococcal Infections. ACS Infect Dis 2024; 10:2961-2977. [PMID: 39066703 DOI: 10.1021/acsinfecdis.4c00293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
The primary obstacles in the management of Enterococcus and Streptococcal infections are drug resistance and biofilm formation. Our study revealed that loratadine at a concentration of ≥25 μM exhibited significant inhibitory effects on biofilm formation in 167 clinical strains of Enterococcus faecalis and 15 clinical isolates of Streptococcus agalactiae, Streptococcus pyogenes, and Streptococcus pneumoniae. Additionally, the antibiofilm activity against E. faecalis and Streptococcal was demonstrated by several loratadine derivatives with altered side-chain carbamate moieties. This study investigated the antibacterial activity of the loratadine derivative Lo-7 against clinical strains of S. agalactiae and S. pyogenes, with minimum inhibitory concentrations ranging from 12.5 to 25 μM. The findings revealed that a low concentration of loratadine derivative Lo-7 (3.125 μM) significantly augmented the bactericidal efficacy of vancomycin against multidrug-resistant (MDR) S. agalactiae, both in vitro and in vivo. The loratadine derivative Lo-7, even at low concentrations, demonstrated significant efficacy in eliminating intracellular MDR S. agalactiae within macrophages, potentially indicating a unique advantage over vancomycin, linezolid, and loratadine. Mechanistically, exposure to the loratadine derivative Lo-7 resulted in membrane depolarization without affecting membrane permeability in S. agalactiae. The potential targeting of the SecG subunit of the SecYEG membrane-embedded channel by the loratadine derivative Lo-7 in S. agalactiae was identified through quantitative proteomics, a drug affinity responsive target stability assay, and molecular docking.
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Affiliation(s)
- Xinyi Cao
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
- Department of Microbiology, The First Affiliated Hospital of Jiamusi University, Jiamusi 154003, China
| | - Wei Li
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Zhichao Xu
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Guiqiu Li
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Zewen Wen
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Qingyin Meng
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Peiyu Li
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Zhijian Yu
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Zhong Chen
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
| | - Jinxin Zheng
- Department of Infectious Diseases, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen University Medical School, Shenzhen 518052, China
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Kou X, An D. A 48-year-old man with fever, nauseous, vomiting, and dizzy: A CARE case report. Medicine (Baltimore) 2024; 103:e39015. [PMID: 39093751 PMCID: PMC11296406 DOI: 10.1097/md.0000000000039015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Listeria monocytogenes (LM) is an important foodborne bacterium, and LM meningoencephalitis is rare in clinical practice, with poor prognosis in severe patients. It is prone to misdiagnosis in clinical practice. We first reported a case of severe LM meningoencephalitis with muscle lesions and evaluated the comprehensive condition. PATIENT CONCERNS A 48-year-old man had a fever and was admitted to the neurology department due to dizziness, nausea, and vomiting for 20 days. DIAGNOSES LM meningoencephalitis complicated with muscle lesions. INTERVENTIONS We used moxifloxacin 0.4 g, qd, meropenem 2 g, q8h, and dexamethasone 10 mg, qd to reduce exudation and adhesion. Then due to consideration of side effects, we increased the dose of ampicillin by 2 g, q4h, stopped using meropenem and moxifloxacin, and turned to maintenance treatment with dexamethasone and ampicillin. We comprehensively managed his vital signs and physical organ functions, we also controlled some comorbidities. During the hospitalization period thereafter, we used intravenous anti-infection treatment with moxifloxacin 0.4 g, qd, ampicillin 0.5 g, q4h. OUTCOMES Half a year later, the reexamination showed only protein elevation in cerebrospinal fluid and hydrocephalus in MRI. Afterward, the symptoms did not recur again. The patient recovered well after discharge. LESSONS LM meningoencephalitis complicated with lower limb muscle lesions is clinically rare. This report focuses on relevant treatment plans, which provide value for the examination and comprehensive management of patients with LM infection in the future.
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Affiliation(s)
- Xingbo Kou
- Department of Thoracic Surgery, Shangluo Central Hospital, Shangluo, China
| | - Dinghao An
- Department of Neurology, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
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Bjar N, Hermansson A, Gisselsson-Solen M. How common is otogenic meningitis? A retrospective study in southern Sweden over 18 years. Infection 2024; 52:1377-1384. [PMID: 38416397 PMCID: PMC11289216 DOI: 10.1007/s15010-024-02195-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Bacterial meningitis is a rare, but life-threatening disease, which sometimes occurs as a complication to acute otitis media (AOM). The proportion of meningitis cases originating from AOM is not clear. PURPOSE The aim of this study was to investigate the proportion of meningitis cases caused by AOM, to compare risk factors, bacteriology and outcome between otogenic and non-otogenic meningitis, and to analyse the incidence of bacterial meningitis after the introduction of conjugate pneumococcal vaccines (PCV). METHODS The medical charts of all patients admitted to hospitals in southern Sweden with bacterial meningitis between 2000 and 2017 were retrieved. Based on otoscopy and/or imaging, the proportion of otogenic meningitis cases was calculated, as were annual incidences. RESULTS A total of 216 patients were identified, 25 of whom died. The proportion of otogenic meningitis was 31% but varied from 6% among teenagers to 40% among adults. Before PCV, 23% of all meningitis cases were children < 2 years, compared to 1% post-PCV. The average incidence in the adult population, on the other hand, increased post-PCV, though there were large annual variations. S. pneumoniae was the most commonly identified pathogen in everyone but teenagers, in whom N. meningitidis was predominant. CONCLUSION AOM is an important cause of meningitis in children and adults. Though bacterial meningitis almost disappeared in children < 2 years after the introduction of PCV, the incidence of pneumococcal meningitis in adults seems to have increased.
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Affiliation(s)
- Nora Bjar
- Vårdcentralen Lunden, Ystadgatan 53c, 214 44, Malmö, Sweden
| | - Ann Hermansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, 221 85, Lund, Sweden
| | - Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, 221 85, Lund, Sweden.
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Gao Y, Hu F. Predictive role of PAR and LAR in refractory suppurative meningitis in infants. BMC Pediatr 2024; 24:462. [PMID: 39026204 PMCID: PMC11264845 DOI: 10.1186/s12887-024-04898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Meningitis can be caused by a variety of pathogenic microorganisms, which can lead to higher mortality and disability rates. However, the clinical manifestations of suppurative meningitis are often atypical in infants and young children, which makes early clinical diagnosis difficult.PAR and LAR are considered as a novel inflammatory biomarker and have been applied in tumors, IgA nephropathy, sepsis. OBJECTIVE To investigate the application of platelet/albumin (PAR) and lactate dehydrogenase/albumin (LAR) in refractory suppurative meningitis in infants. METHODS The relevant clinical data of 107 children with suppurative meningitis were retrospectively analyzed, and were divided into common group (82 cases) and refractory group (25 cases) according to the severity of the disease according to the relevant clinical consensus. The relevant clinical data and laboratory examination of the children in the two groups were compared. The diagnostic value of PAR and LAR in children with refractory suppurative meningitis was analyzed and multivariate Logistic regression analysis was performed. RESULT The PAR of children with suppurative meningitis in refractory group was lower than that in common group (P < 0.05), while LAR was higher than that in common group (P < 0.05). Meanwhile, multivariate Logistic regression analysis showed that LAR and cerebrospinal fluid glucose ≤ 1.5mmo/L were risk factors for poor prognosis (OR > 1, P < 0.05). PAR was a protective factor (OR < 1, P < 0.05). CONCLUSION PAR and LAR can be used for early diagnosis of refractory suppurative meningitis in children as protective and risk factors, respectively.
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Affiliation(s)
- YaSong Gao
- Department of Pediatrics, Anqing Municipal Hospital, Anqing, Anhui, 246000, China
| | - FangQi Hu
- Department of Pediatrics, Anqing Municipal Hospital, Anqing, Anhui, 246000, China.
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Dambietz C, Heming M, Brix TJ, Schulte-Mecklenbeck A, Tepasse PR, Gross CC, Trebicka J, Wiendl H, Zu Hörste GM. Severe CSF immune cell alterations in cryptococcal meningitis gradually resolve during antifungal therapy. BMC Neurol 2024; 24:229. [PMID: 38961320 PMCID: PMC11221170 DOI: 10.1186/s12883-024-03742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/21/2024] [Indexed: 07/05/2024] Open
Abstract
Cryptococcal meningitis (CM) is a severe fungal disease in immunocompromised patients affecting the central nervous system (CNS). Host response and immunological alterations in the cerebrospinal fluid (CSF) after invasion of Cryptococcus neoformans to the central nervous system have been investigated before but rigorous and comprehensive studies examining cellular changes in the CSF of patients with cryptococccal meningitis are still rare. We retrospectively collected CSF analysis and flow cytometry data of CSF and blood in patients with CM (n = 7) and compared them to HIV positive patients without meningitis (n = 13) and HIV negative healthy controls (n = 7). Within the group of patients with CM we compared those with HIV infection (n = 3) or other immunocompromised conditions (n = 4). Flow cytometry analysis revealed an elevation of natural killer cells and natural killer T cells in the CSF and blood of HIV negative patients with CM, pointing to innate immune activation in early stages after fungal invasion. HIV positive patients with CM exhibited stronger blood-CSF-barrier disruption. Follow-up CSF analysis over up to 150 days showed heterogeneous cellular courses in CM patients with slow normalization of CSF after induction of antifungal therapy.
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Affiliation(s)
- Christine Dambietz
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany
| | - Michael Heming
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany
| | - Phil-Robin Tepasse
- Department of Gastroenterology, Hepatology, Endocrinology and Infectiology, University Hospital Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany
| | - Jonel Trebicka
- Department of Gastroenterology, Hepatology, Endocrinology and Infectiology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany
| | - Gerd Meyer Zu Hörste
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1 48149, Münster, Germany.
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Subbian S, Venketaraman V. Editorial: Advances in the management of tuberculosis meningitis. Front Immunol 2024; 15:1433345. [PMID: 38933279 PMCID: PMC11199771 DOI: 10.3389/fimmu.2024.1433345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Selvakumar Subbian
- Public Health Research Institute Center at New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Vishwanath Venketaraman
- Department of Basic Medical Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
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Villalpando-Carrión S, Henao-Martínez AF, Franco-Paredes C. Epidemiology and Clinical Outcomes of Bacterial Meningitis in Children and Adults in Low- and Middle-Income Countries. CURRENT TROPICAL MEDICINE REPORTS 2024; 11:60-67. [PMID: 39006487 PMCID: PMC11244613 DOI: 10.1007/s40475-024-00316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 07/16/2024]
Abstract
Purpose of Review Despite the availability of effective vaccines against the three primary pathogens (Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis) that cause bacterial meningitis, this condition remains a significant cause of morbidity, neurologic sequelae, and mortality among children and adults living in low-income and middle-income countries. Recent Findings Bacterial meningitis represents a significant public health challenge for national and global health systems. Since vaccine-preventable meningitis remains highly prevalent in low-income and middle-income countries, the World Health Organization (WHO) recently developed a global roadmap to defeating meningitis by 2030 and ameliorating its associated neurological sequelae. Summary There is a need for a global approach to surveillance and prevention of bacterial meningitis. Increasing vaccination coverage with conjugate vaccines against pneumococcus and meningococcus with optimal immunization schedules are high-value healthcare interventions. Additionally, overcoming diagnostic challenges and the early institution of empirical antibiotic therapy and, when feasible, adjunctive steroid therapy constitutes the pillars of reducing the disease burden of bacterial meningitis in resource-limited settings.
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Affiliation(s)
- Salvador Villalpando-Carrión
- Hospital Infantil de México, Federico Gómez, Doctor Marquéz No. 162, Col. Doctores, Delegación Cuauhtémoc, 06720 CDMX, Mexico City, CP, Mexico
| | | | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, Doctor Marquéz No. 162, Col. Doctores, Delegación Cuauhtémoc, 06720 CDMX, Mexico City, CP, Mexico
- Division of Microbiology, Immunology, and Pathology, Colorado State University, Aurora, CO, USA
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Cergole-Novella MC, Matsuda EM, de Souza MB, Colpas DR, Carmo AMDS, Daros VDSMG, Campos IB. Recurrent community-acquired pneumococcal meningitis in adults with and without identified predisposing factors. Braz J Microbiol 2024; 55:1339-1348. [PMID: 38438832 PMCID: PMC11153432 DOI: 10.1007/s42770-024-01292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Bacterial meningitis is still a significant public health concern, with high morbidity and mortality rates. Despite this, it is still a rare event that requires the bacterial invasion of the meninges. However, some predisposing factors can trigger recurrent episodes of meningitis. This study is aimed at determining the clinical characteristics and the molecular epidemiology of episodes of recurrent community-acquired meningitis with and without predisposing factors. For this purpose, we performed a retrospective study of our laboratory database during the period of 2010 to 2020. Additionally, using molecular tools developed in our previous works, the epidemiology of the pathogens causing these episodes was analyzed using cerebrospinal fluid samples, especially in the absence of isolated strains. We observed a total of 1,779 meningitis cases and 230 were caused by Streptococcus pneumoniae. Of those, 16 were recurrent meningitis episodes (16/1,779; 0.9%) from seven patients. Pneumococcus was the main agent responsible in these recurrent episodes and only two episodes were caused by Haemophilus influenzae. The mean age of these patients was 20 years old and three had predisposing factors which could have led to contracting meningitis. The samples presented different pneumococcal serotypes. Most of them were non-vaccine-covered serotypes and antibiotic susceptible strains. Therefore, it was demonstrated how the practical employment of molecular tools, developed for research, when applied in the routine of diagnosis, can provide important information for epidemiological surveillance. Furthermore, it was shown how pneumococcus was the leading cause of recurrent community-acquired meningitis without predisposing factors, suggesting that pneumococcal vaccination may be necessary, even in those groups of individuals considered to be less susceptible.
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Affiliation(s)
- Maria Cecilia Cergole-Novella
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Elaine Monteiro Matsuda
- City Hall of Santo André, Santo André Health Secretary, Rua Primeiro de Maio, 133 - Centro, Santo André, SP, 09015-030, Brazil
| | - Mariana Brena de Souza
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Daniela Rodrigues Colpas
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | - Andréia Moreira Dos Santos Carmo
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil
| | | | - Ivana Barros Campos
- Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil.
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Reynolds AS. Neuroinfectious Emergencies. Continuum (Minneap Minn) 2024; 30:757-780. [PMID: 38830070 DOI: 10.1212/con.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article describes nervous system infections and complications that lead to neurologic emergencies. LATEST DEVELOPMENTS New research on the use of dexamethasone in viral and fungal infections is reviewed. The use of advanced MRI techniques to evaluate nervous system infections is discussed. ESSENTIAL POINTS Neurologic infections become emergencies when they lead to a rapid decline in a patient's function. Emergent complications may result from neurologic infections that, if not identified promptly, can lead to permanent deficits or death. These complications include cerebral edema and herniation, spinal cord compression, hydrocephalus, vasculopathy resulting in ischemic stroke, venous thrombosis, intracerebral hemorrhage, status epilepticus, and neuromuscular respiratory weakness.
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Lv Z, Liu Y. Clinical research progress on intrathecal glucocorticoids in the treatment of infections: A review. Medicine (Baltimore) 2024; 103:e38123. [PMID: 38758886 PMCID: PMC11098166 DOI: 10.1097/md.0000000000038123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
In some infectious diseases, pathogenic microorganisms can directly or indirectly cause significant inflammatory reactions in the central nervous system, leading to severe neurological dysfunction, such as suppurative meningitis, tuberculous meningitis, and febrile infections. related epilepsy syndrome, etc. In these diseases, adjuvant administration of glucocorticoids is necessary to inhibit the release of proinflammatory cytokines, and intrathecal administration can deliver the drug more directly to the target. In this article, the authors studied intrathecal glucocorticoids for the treatment of infectious inflammatory reactions in terms of pharmacological effects and mechanisms, pharmacokinetics, clinical application, and safety. The authors concluded that the article could help provide new treatment strategies for infectious diseases.
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Affiliation(s)
- Zixv Lv
- Department of Pain, Zibo First Hospital, Zibo, Shandong, China
| | - Yingying Liu
- Department of Neurosurgery, Zibo First Hospital, Zibo, Shandong, China
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Akaishi T, Tarasawa K, Fushimi K, Ota C, Sekiguchi S, Aoyagi T, Yaegashi N, Aoki M, Fujimori K. A Reduction in the Number of Hospitalized Cases of Acute Meningitis during the COVID-19 Pandemic in Japan. Intern Med 2024; 63:1353-1359. [PMID: 38432966 PMCID: PMC11157317 DOI: 10.2169/internalmedicine.3022-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The changes in the prevalence of acute meningitis during the coronavirus disease 2019 (COVID-19) pandemic remain unclear. This study aimed to compare the prevalence of acute meningitis before and during the COVID-19 pandemic in Japan. Methods We retrospectively reviewed the Japanese nationwide administrative medical payment system database, Diagnosis Procedure Combination (DPC), from 2016 to 2022. A total of 547 hospitals consistently and seamlessly offered DPC data during this period. The study period was divided into the following three periods: April 2016 to March 2018 (fiscal years 2016-2017), April 2018-March 2020 (2018-2019), and April 2020-March 2022 (2020-2021). Results Among the 28,161,806 patients hospitalized during the study period, 28,399 were hospitalized for acute meningitis: 16,678 for viral/aseptic type, 6,189 for bacterial type, 655 for fungal type, 429 for tuberculous, 2,310 for carcinomatous type, and 2,138 for other or unknown types of meningitis. A significant decrease during the pandemic was confirmed in viral (n=7,032, n=5,775, and n=3,871 in each period; p<0.0001) and bacterial meningitis (n=2,291, n=2,239, and n=1,659; p<0.0001) cases. Meanwhile, no decrease was observed in fungal meningitis (n=212, n=246, and n=197; p=0.056) or carcinomatous meningitis (n=781, n=795, and n=734; p=0.27). The decrease in the number of tuberculous meningitis cases was equivocal (n=166, n=146, and n=117; p=0.014). The decrease during the pandemic was more remarkable in younger populations aged <50 years than in older populations, both for viral and bacterial meningitis. Conclusion The number of hospitalized cases of acute meningitis clearly decreased during the COVID-19 pandemic, especially for viral and bacterial meningitis in younger populations aged <50 years.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Japan
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Japan
| | | | - Tetsuji Aoyagi
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Japan
| | - Nobuo Yaegashi
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
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Liu T, Liu H, Jia Y. Streptococcus suis meningitis in China: a case report. Front Public Health 2024; 12:1369703. [PMID: 38808002 PMCID: PMC11130402 DOI: 10.3389/fpubh.2024.1369703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Streptococcus suis is one of the porcine pathogens that have recently emerged as a pathogen capable of causing zoonoses in some humans. Patients infected with S. suis can present with sepsis, meningitis, or arthritis. Compared to common pathogens, such as Meningococcus, Streptococcus pneumoniae, and Haemophilus influenzae, S. suis infections in humans have been reported only rarely. Methods This case report described a 57-year-old man who presented with impaired consciousness and fever following several days of backache. He was a butcher who worked in an abattoir and had wounded his hands 2 weeks prior. The patient was dependent on alcohol for almost 40 years. S. suis was detected in the cerebrospinal fluid by metagenomic next-generation sequencing. Although he received adequate meropenem and low-dose steroid therapy, the patient suffered from bilateral sudden deafness after 5 days of the infection. The final diagnosis was S. suis meningitis and sepsis. Results The patient survived with hearing loss in both ears and dizziness at the 60-day follow-up. Discussion We reported a case of S. suis infection manifested as purulent meningitis and sepsis. Based on literature published worldwide, human S. suis meningitis shows an acute onset and rapid progression in the nervous system. Similar to bacterial meningitis, effective antibiotics, and low-dose steroids play important roles in the treatment of human S. suis meningitis.
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Affiliation(s)
- Tiantian Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hengfang Liu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang J, Meng Y, Zhang R, Yan H, Xu G, Zhu Y, Xie Z, Jiang S. Coagulase-negative staphylococci are the main causes of bacterial meningitis in duck. Poult Sci 2024; 103:103592. [PMID: 38447309 PMCID: PMC11067754 DOI: 10.1016/j.psj.2024.103592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
Since September 2018, serious meningitis has been found on some breeding-duck farms in Shandong Province, China. A large number of ducks exhibit severe neurological symptoms. The ducks were randomly selected for laboratory testing. Duck brain samples were collected using standard sterile techniques, and the staphylococci isolates were detected in 404 (70.14%) out of 576 brain samples. A total of 525 coagulase-negative staphylococci (CoNS) strains were isolated, including 6 species: Staphylococcus sciuri (S. sciuri) (67.24%, 353/525), Staphylococcus epidermidis (S. epidermidis) (9.71%, 51/525), Staphylococcus saprophyticus (S. saprophyticus) (8.38%, 44/525), Staphylococcus lentus (S. lentus) (7.62%, 40/525), Staphylococcus haemolyticus (S. haemolyticus) (2.48%, 13/525), and Staphylococcus xylosus (S. xylosus) (4.57%, 24/525). Mixed strain infections were detected in 121 (29.95%) infected presentations. The antimicrobial susceptibility testing indicated that 40.38% of the isolates exhibited multi-drug resistance, and 53.90% of the strains were methicillin-resistant strains by amplification of the methicillin resistance gene (mecA) gene. Through experimental reproduction of the disease, we determined that the CoNS strains were the leading pathogens causing bacterial meningitis in ducks. Although these CoNS strains does not directly cause the death of sick ducks, they still cause large economic losses due to the retarded growth and development of the sick ducks, lower feed returns, and lower grades of processed duck products. The results of this study will contribute to our understanding of the epidemiology and pathogenesis of CoNS and be helpful in the prevention and treatment of the infection.
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Affiliation(s)
- Jingyu Wang
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Yu Meng
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Ruihua Zhang
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Hui Yan
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Guige Xu
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Yanli Zhu
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Zhijing Xie
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China
| | - Shijin Jiang
- Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Shandong Agricultural University, Tai'an 271018, China; Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, Tai'an 271018, China; Shandong Provincial Engineering Technology Research Center of Animal Disease Control and Prevention, Tai'an 271018, China.
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Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and Viral Infectious Disease of the Spine. Magn Reson Imaging Clin N Am 2024; 32:313-333. [PMID: 38555143 DOI: 10.1016/j.mric.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
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Affiliation(s)
- Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA.
| | - Amy M Condos
- Department of Radiology, University of Washington School of Medicine, 2545 Northeast 85th Street Seattle, WA 98115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Dyckhoff-Shen S, Pfister HW, Koedel U, Klein M. PCR-positive meningococcal CSF infection without pleocytosis but high IL-6 and IL-8. Infection 2024:10.1007/s15010-024-02275-0. [PMID: 38678151 DOI: 10.1007/s15010-024-02275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Meningococcal meningitis is still a severe disease causing high mortality and morbidity rates. Early diagnosis is crucial to ensure prompt antibiotic therapy. However, identification of the pathogen can be challenging. CASE PRESENTATION A 32-year-old male patient with systemic lupus erythematosus (SLE) presented to the emergency room with fever, nausea, vomiting, headache and lower back pain as well as multiple petechial bleedings. On suspicion of meningococcal infection, the emergency doctor had already administered one dose of ceftriaxone before arrival to the clinic. Blood works showed massive inflammation due to bacterial infection. Cerebrospinal fluid (CSF) analysis showed normal cell count, protein and glucose levels but PCR was positive for Neisseria meningitis and IL-6 as well as IL-8 were elevated. On antibiotic therapy with ceftriaxone, the patient's condition improved quickly. CONCLUSIONS We present a rare case of meningococcal infection of the CSF in a SLE patient without further CSF abnormalities. We discuss the involvement of early antibiotic treatment and the role of the patient's immune status in the normal CSF findings of this case. Moreover, this case demonstrates the importance of early antibiotic therapy in bacterial meningitis for the clinical outcome.
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Affiliation(s)
- Susanne Dyckhoff-Shen
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Hans-Walter Pfister
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Uwe Koedel
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Klein
- Department of Neurology with Friedrich-Baur-Institute, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Emergency Department, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Lamounier P, Carasek N, Daher VB, Costa CC, Ramos HVL, Martins SDC, Borges ALDF, Oliveira LAT, Bahmad Jr F. Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests. J Pers Med 2024; 14:428. [PMID: 38673055 PMCID: PMC11050886 DOI: 10.3390/jpm14040428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.
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Affiliation(s)
- Pauliana Lamounier
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Natalia Carasek
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
| | - Valeria Barcelos Daher
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Claudiney Cândido Costa
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Hugo Valter Lisboa Ramos
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | - Sergio de Castro Martins
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
- Otorhinolaryngology Department, Universidade Estadual de Goiás (UEG), Itumbiara 75536-100, Brazil
| | - Alda Linhares de Freitas Borges
- Department of Otolaryngology, Center of Rehabilitation and Readaptation Dr Henrique Santillo (CRER), Goiania 74653-230, Brazil; (P.L.); (V.B.D.); (C.C.C.); (H.V.L.R.); (S.d.C.M.); (A.L.d.F.B.)
| | | | - Fayez Bahmad Jr
- Department of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil; (N.C.); (L.A.T.O.)
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Yang X, Wang Y, Zhao S, Huang X, Tian B, Yu R, Ding Q. Clinical characteristics and prognosis of Klebsiella pneumoniae meningitis in adults. Heliyon 2024; 10:e28010. [PMID: 38601552 PMCID: PMC11004708 DOI: 10.1016/j.heliyon.2024.e28010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Klebsiella pneumoniae is a causative agent of bacterial meningitis in adults. However, there is little information regarding this infection. Therefore, this study comprehensively analyzed the clinical characteristics and prognosis of Klebsiella pneumoniae meningitis (KPM) patients. Methods The clinical data of adult hospitalized patients with KPM were retrospectively collected from January 2015 to December 2022. The clinical characteristics and antibiotic resistance of KPM were evaluated. Meanwhile, a set of logistic regression models was constructed to identify prognostic factors for death. These prognostic factors were subsequently combined to develop a nomogram for predicting the risk of in-hospital mortality in individual patients. Finally, the receiver operating characteristic curve and calibrate plot were utilized to verify the performance of the nomogram. Results This study included 80 adult patients with KPM, 58 (72.5%) of whom were males. The mortality rate was 45%. Among them, 74 (92.5%) were diagnosed with healthcare-associated meningitis. Thirty-seven carbapenem-resistant Klebsiella pneumoniae (CRKP) strains were susceptible to tigecycline, polymyxin, and ceftazidime/avibactam. CRKP (OR = 9.825, 95%CI = 2.757-35.011, P < 0.001), length of stay (OR = 0.953, 95%CI = 0.921-0.986, P = 0.005), and C-reactive protein-to-prealbumin ratio (CRP/PA, OR = 3.053, 95%CI = 1.329-7.016, P = 0.009) were identified as predictive factors for mortality using multivariate logistic regression. Finally, a nomogram for death prediction was established. The area under the curve of this nomogram was 0.900 (95% CI = 0.828-0.971). Conclusions KPM is a fatal disease associated with high incidence of healthcare-associated infections and carbapenem resistance. Moreover, CRKP, length of stay, and CRP/PA were found to be independent predictors of mortality.
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Affiliation(s)
- Xin Yang
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yanjun Wang
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Siqi Zhao
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiaoya Huang
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Bingxin Tian
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Runli Yu
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Qin Ding
- Department of Infectious Disease and Hepatic Disease, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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18
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Karabacak M, Schupper AJ, Carr MT, Hickman ZL, Margetis K. From Text to Insight: A Natural Language Processing-Based Analysis of Topics and Trends in Neurosurgery. Neurosurgery 2024; 94:679-689. [PMID: 37988054 DOI: 10.1227/neu.0000000000002763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neurosurgical research is a rapidly evolving field, with new research topics emerging continually. To provide a clearer understanding of the evolving research landscape, our study aimed to identify and analyze the prevalent research topics and trends in Neurosurgery. METHODS We used BERTopic, an advanced natural language processing-based topic modeling approach, to analyze papers published in the journal Neurosurgery . Using this method, topics were identified based on unique sets of keywords that encapsulated the core themes of each article. Linear regression models were then trained on the topic probabilities to identify trends over time, allowing us to identify "hot" (growing in prominence) and "cold" (decreasing in prominence) topics. We also performed a focused analysis of the trends in the current decade. RESULTS Our analysis led to the categorization of 12 438 documents into 49 distinct topics. The topics covered a wide range of themes, with the most commonly identified topics being "Spinal Neurosurgery" and "Treatment of Cerebral Ischemia." The hottest topics of the current decade were "Peripheral Nerve Surgery," "Unruptured Aneurysms," and "Endovascular Treatments" while the cold topics were "Chiari Malformations," "Thromboembolism Prophylaxis," and "Infections." CONCLUSION Our study underscores the dynamic nature of neurosurgical research and the evolving focus of the field. The insights derived from the analysis can guide future research directions, inform policy decisions, and identify emerging areas of interest. The use of natural language processing in synthesizing and analyzing large volumes of academic literature demonstrates the potential of advanced analytical techniques in understanding the research landscape, paving the way for similar analyses across other medical disciplines.
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Affiliation(s)
- Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York , New York , USA
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19
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Li Y, Wang L, Gao Z, Zhou J, Xie S, Li G, Hou C, Wang Z, Lv Z, Wang R, Han G. Neuropeptide Calcitonin Gene-Related Peptide Promotes Immune Homeostasis of Bacterial Meningitis by Inducing Major Histocompatibility Complex Class II Ubiquitination. J Infect Dis 2024; 229:855-865. [PMID: 37603461 DOI: 10.1093/infdis/jiad358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP), an immunomodulatory neuropeptide, is important for regulating pain transmission, vasodilation, and the inflammatory response. However, the molecular mechanisms of the CGRP-mediated immune response remain unknown. METHODS The effects of CGRP on bacterial meningitis (BM) and its underlying mechanisms were investigated in BM mice in vivo and macrophages in vitro. RESULTS Peripheral injection of CGRP attenuated cytokine storms and protected mice from fatal pneumococcal meningitis, marked by increased bacterial clearance, improved neuroethology, and reduced mortality. When the underlying mechanisms were investigated, we found that CGRP induces proteasome-dependent degradation of major histocompatibility complex class II (MHC-II) in macrophages and then inhibits CD4+ T-cell activation. MARCH1 was identified as an E3 ligase that can be induced by CGRP engagement and promote K48-linked ubiquitination and degradation of MHC-II in macrophages. These results provide new insights into neuropeptide CGRP-mediated immune regulation mechanisms. CONCLUSIONS We conclude that targeting the nervous system and manipulating neuroimmune communication is a promising strategy for treating intracranial infections like BM.
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Affiliation(s)
- Yuxiang Li
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Lanying Wang
- Joint National Laboratory for Antibody Drug Engineering, School of Medicine, Henan University, Kaifeng
| | - Zhenfang Gao
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Jie Zhou
- Joint National Laboratory for Antibody Drug Engineering, School of Medicine, Henan University, Kaifeng
| | - Shun Xie
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Ge Li
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Chunmei Hou
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Zhiding Wang
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
| | - Zhonglin Lv
- Department of Hematology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing
| | - Renxi Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Gencheng Han
- Department of Neuroimmune and Antibody Engineering, Beijing Institute of Basic Medical Sciences, Beijing
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20
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Ganti L, Veluri SC, Stead TS, Rieck R. Ominous Causes of Headache. Curr Pain Headache Rep 2024; 28:73-81. [PMID: 38091239 DOI: 10.1007/s11916-023-01202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE OF REVIEW While primary headaches like migraines or cluster headaches are prevalent and often debilitating, it's the secondary headaches-those resulting from underlying pathologies-that can be particularly ominous. This article delves into the sinister causes of headaches, underscoring the importance of a meticulous clinical approach, especially when presented with red flags. RECENT FINDINGS Headaches, one of the most common complaints in clinical practice, span a spectrum from benign tension-type episodes to harbingers of life-threatening conditions. For the seasoned physician, differentiating between these extremes is paramount. Headache etiologies covered in this article will include subarachnoid hemorrhage (SAH), cervical artery dissection, cerebral venous thrombosis, meningitis, obstructive hydrocephalus, and brain tumor.
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Affiliation(s)
- Latha Ganti
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
- University of Central Florida College of Medicine, Orlando, FL, USA.
- Envision Healthcare, Nashville, TN, USA.
| | | | - Thor S Stead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Kachuei M, Zare R, Sayyahfar S, Khalili M, Movahedi H, Naghshbandi M, Eghdami S. An unusual imaging presentation of pediatric bacterial meningoencephalitis: a case-report study. Ann Med Surg (Lond) 2024; 86:1739-1744. [PMID: 38463079 PMCID: PMC10923334 DOI: 10.1097/ms9.0000000000001749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024] Open
Abstract
Background Bacterial meningoencephalitis is a serious infection affecting the brain and its surrounding membranes. While imaging studies play a crucial role in diagnosing this condition, the typical radiological findings are well-documented. However, this case report describes an unusual imaging presentation that deviates from the expected patterns, emphasizing the need for awareness of such variations. Case presentation A 7-year-old female with no prior medical history was referred to our hospital with fever, seizure, and loss of Consciousness. She had mild flu a week before admission. The duration of seizure episodes were 2-3 min, with tonic-clonic uncontrollable jerky movements. Brudzinski and Kernig signs were positive and plantar reflex was upward bilaterally in the physical examination. The computed tomography (CT) scan showed brain ventriculomegaly/hydrocephalus, and MRI findings indicated multiple foci located at cerebellum, basal ganglia, and thalamus alongside intensely restricted diffusion of the layering debris, suggesting pyogenic ventriculitis. Cerebrospinal fluid (CSF) analysis showed severe hypoglycorrhachia, despite non-significant increase of protein. The patient was undergone antibiotic therapy with ceftriaxone, vancomycin and rifampin, resulting in normalization of CSF values. Conclusion This case report highlights the importance of recognizing and interpreting unusual imaging presentations of bacterial meningoencephalitis in paediatric patients. It emphasizes the need for a comprehensive diagnostic approach, including clinical evaluation, laboratory tests, and imaging studies, to ensure accurate diagnosis and appropriate management of this potentially life-threatening condition. Further research and awareness of atypical imaging findings are warranted to enhance our understanding and improve patient outcomes.
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Affiliation(s)
- Maryam Kachuei
- Firoozabadi Clinical Research Development Unit (FACRDU), School of Medicine, Iran University of Medical Sciences
| | - Ramin Zare
- Firoozabadi Clinical Research Development Unit (FACRDU), School of Medicine, Iran University of Medical Sciences
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences
| | - Mitra Khalili
- Department of Radiology, Shahid Beheshti University of Medical Sciences
| | | | | | - Shayan Eghdami
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
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Liu L, Zhu L, Hu C, Zhu S, Ye S. Rare Cases of Pseudomonas aeruginosa Meningitis in Children: 10-Year Experience in a Single Center. J Child Neurol 2024; 39:113-121. [PMID: 38488459 DOI: 10.1177/08830738241239703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The primary objective was to elucidate the epidemiologic characteristics, risk determinants, and clinical outcomes associated with Pseudomonas aeruginosa-induced meningitis. METHODS All cases of meningitis caused by Pseudomonas aeruginosa that were treated at the hospital between 2012 and 2022 were retrospectively analyzed and detailed. RESULTS During a 10-year period, only 10 patients satisfied the inclusion criteria. Three patients had previously undergone neurosurgical procedures and 4 patients had leukemia. CONCLUSIONS Although Pseudomonas aeruginosa meningitis possesses a low incidence rate, the rate of mortality is high. Patients with leukemia or those who have undergone neurosurgery are the most susceptible to diagnosis. Cases of severe neutropenia present only mild or no cerebrospinal fluid pleocytosis. In patients with sensitive Pseudomonas aeruginosa meningitis, the timely use of anti-Pseudomonas carbapenems for intravenous treatment is highly effective. For drug-resistant Pseudomonas aeruginosa meningitis, intrathecal polymyxins administration can be an effective treatment option.
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Affiliation(s)
- Lijun Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lvchang Zhu
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chanchan Hu
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuzhen Zhu
- Department of Emergency, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Sheng Ye
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Olowoyo P, Adeniji O, Akinyemi R, Owolabi M. Maintenance of brain health: The role of social determinants of health and other non-traditional cardiovascular risks. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100213. [PMID: 39071740 PMCID: PMC11273091 DOI: 10.1016/j.cccb.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 07/30/2024]
Abstract
Brain health is the complete functioning of the brain across the life course to support the full physical, mental, social, and spiritual well-being and quality of life of an individual towards attaining and maintaining the epitome of a meaningful, impactful, purposeful, and productive life. The determinants of brain health are complex and include at least in part, non-traditional risks such as interactions among social, economic, physical, and internal factors (e.g., emotions and adaptations to changing life experiences), and external factors such as environment, geography, and climate change. Thus, social determinants of health (e.g., where we work, live, and play) are those non-medical factors that influence health outcomes, and as non-traditional cardiovascular factors, may influence the development of traditional cardiovascular risks. Examples of the non-traditional cardiovascular factors include environmental stressors (e.g., climate change, air pollution), and psychological and physical abuse. In this article, we provide a discussion of social determinants of health and other non-traditional cardiovascular risks as they relate to brain health.
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Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - Olaleye Adeniji
- Neurology Unit, Department of Internal Medicine, Federal Medical Center, Abeokuta, Ogun State, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
- Lebanese American University of Beirut, Lebanon
- Blossom Specialist Medical Center, Ibadan, Nigeria
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Ghoweba Y, Safizadeh Shabestari SA, Malik ZA. Diagnostic Accuracy of Cerebrospinal Fluid Multiplex Polymerase Chain Reaction Panel Testing in Patients With Suspected Central Nervous System Infections: A Multi-Center Study in the United Arab Emirates. Cureus 2024; 16:e51906. [PMID: 38333447 PMCID: PMC10851033 DOI: 10.7759/cureus.51906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
Background Delays in diagnosis and treatment of central nervous system (CNS) infections can lead to significant morbidity and mortality among children and adults. Prior antibiotic treatment is a major hurdle to accurate diagnosis due to falsely negative cerebrospinal fluid (CSF) cultures in partially treated patients. Increasingly, molecular diagnostic methods using multiplex polymerase chain reaction (mPCR) testing on CSF samples are being utilized in clinical practice for timely and accurate diagnosis. However, there is no data regarding the diagnostic accuracy or clinical impact of CSF mPCR testing in the Middle East region. We sought to compare the diagnostic accuracy of an automated mPCR CSF panel with routine CSF culture, the current gold standard, in the United Arab Emirates (UAE). Methods This single-gated, multi-center, diagnostic accuracy study included patients from birth onwards who were admitted to any of the three participating hospitals with an initial diagnosis of meningitis or encephalitis, between January 2017 and March 2021, and had CSF samples collected for mPCR and culture. Sociodemographic, clinical, and molecular data were collected for all. Results A total of 353 CSF samples were collected from patients from 0-90 years old hospitalized for suspected CNS infection. Children constituted 51% of the study population, and males were slightly over-represented (55.2%). Pathogens were detected by mPCR in 78 (22%) CSF samples, of which 19 (24%) were bacteria and 59 (76%) were viruses. No fungal pathogens were detected. Enteroviruses were the most prevalent CNS pathogen among our cohort (40%), followed by herpes simplex virus type 2 (HSV-2) (12.5%). Children constituted 69% of positive samples for enterovirus, while HSV-2 was exclusively detected among adults. Using CSF culture as the diagnostic gold standard, the mPCR panel demonstrated high specificity (100%) and sensitivity (96.3%) in diagnosing CNS infection among all age groups. mPCR testing demonstrated a high overall percentage of agreement (OPA) with CSF culture (98.9%). Patients with bacterial meningitis had a significantly longer hospitalization (p=0.004) and duration of antibiotic therapy (p=0.001) compared to those with viral meningitis. Three CSF samples were negative on mPCR testing but positive on culture. These pathogens included: methicillin-sensitive Staphylococcus aureus(MSSA), Bacillus cereus, and Mycobacterium Tuberculosis (MTB). In addition, 13 patients had negative CSF cultures but tested positive on CSF mPCR. These pathogens included Streptococcus pneumoniae (seven patients), Haemophilus influenzae (three patients), Streptococcus agalactiae (two patients), and Escherichia coli (one patient). All discordant results were confirmed by reviewing the patient's clinical presentation, CSF analysis, clinical course, and final diagnosis. Conclusion CSF mPCR panel is a highly sensitive and specific diagnostic tool for the diagnosis of CNS infections among all age groups in the UAE. Routine use of CSF mPCR panels can decrease healthcare costs by reducing the length of stay and can also aid antibiotic stewardship efforts by reducing antibiotic overuse in patients with viral CSF infections. CSF culture and mPCR complement each other by identifying CNS pathogens in patients with prior antibiotic exposure who would otherwise be missed if relying on CSF culture alone. However, concomitant CSF culture samples should be sent to avoid missing unusual CNS pathogens.
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Affiliation(s)
- Yousra Ghoweba
- Pediatrics, Mohammed Bin Rashid University Of Medicine and Health Sciences, Dubai, ARE
| | | | - Zainab A Malik
- Pediatrics and Pediatric Infectious Diseases, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE
- Pediatrics and Pediatric Infectious Diseases, Genesis Healthcare, Dubai, ARE
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25
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Kalchev Y, Argirova P, Boev I, Yaneva A, Vatev N, Stoycheva M, Murdjeva M. Cytokine profile in patients with acute bacterial meningitis. Cytokine 2023; 170:156315. [PMID: 37544134 DOI: 10.1016/j.cyto.2023.156315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Bacterial meningitis is a life-threatening disease with high mortality and common long-term sequelae. The inflammatory response in the subarachnoid space, modulated by different cytokines, plays a major role in the pathogenesis of acute central nervous system infections. We aimed to examine correlations of interleukin (IL)-6, IL-8, IL-10, IL-12(p40), and tumor necrosis factor (TNF)-α levels with disease severity, complications, and outcome in patients with acute bacterial meningitis. METHODS The study involved 30 patients with bacterial meningitis/meningoencephalitis admitted to the University Hospital St. George, Plovdiv over a period of 4 years. Patients were selected based on clinical presentation and laboratory abnormalities, consistent with a neuroinfection. Enzyme-linked immunosorbent assay was used to measure the studied cytokines in both cerebrospinal fluid (CSF) and serum in parallel. For microbiological diagnosis multiplex, polymerase chain reaction, and CSF culture were used. RESULTS In patients with acute bacterial meningitis CSF levels of IL-6, IL-8, IL-10, and TNF-α are significantly increased than in serum. CSF TNF-α, CSF IL-8, and CSF IL-10 had a moderate negative correlation to CSF glucose. It was found that serum IL-8 is significantly elevated in patients who experienced neurological complications, have severe clinical course, and in deceased patients. CSF IL-10 is increased only in patients with severe acute bacterial meningitis. CONCLUSION Among patients with acute bacterial meningitis serum IL-8 could delineate these with increased risk of neurological complications, severe clinical course, and fatal outcome. Serum IL-8 and CSF IL-10 could be used as indicators of disease severity.
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Affiliation(s)
- Y Kalchev
- Department of Medical Microbiology and Immunology "Prof. Dr. Elissay Yanev", Faculty of Pharmacy, Medical University - Plovdiv, Bulgaria; Laboratory of Microbiology, University Hospital St. George, Plovdiv, Bulgaria; Research Institute at Medical University - Plovdiv, Bulgaria.
| | - P Argirova
- Department of Infectious Diseases and Parasitology, Faculty of Medicine, Medical University - Plovdiv, Bulgaria
| | - I Boev
- Department of Infectious Diseases and Parasitology, Faculty of Medicine, Medical University - Plovdiv, Bulgaria
| | - A Yaneva
- Department of Medical Informatics, Biostatistics, and eLearning, Faculty of Public Health, Medical University - Plovdiv, Bulgaria
| | - N Vatev
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University - Plovdiv, Bulgaria
| | - M Stoycheva
- Department of Infectious Diseases and Parasitology, Faculty of Medicine, Medical University - Plovdiv, Bulgaria; Clinic of Infectious Diseases, University Hospital St. George, Plovdiv, Bulgaria
| | - M Murdjeva
- Department of Medical Microbiology and Immunology "Prof. Dr. Elissay Yanev", Faculty of Pharmacy, Medical University - Plovdiv, Bulgaria; Laboratory of Microbiology, University Hospital St. George, Plovdiv, Bulgaria; Research Institute at Medical University - Plovdiv, Bulgaria
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26
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Wang Q, Lin Q, Wang H, Tang M, Fan K, Zhang Z, Huang E, Zhang W, Wang F, Ou Q, Liu X. Diagnostic value of cerebrospinal fluid Neutrophil Gelatinase-Associated Lipocalin for differentiation of bacterial meningitis from tuberculous meningitis or cryptococcal meningitis: a prospective cohort study. J Transl Med 2023; 21:603. [PMID: 37679727 PMCID: PMC10486126 DOI: 10.1186/s12967-023-04485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The early differential diagnosis between bacterial meningitis (BM) and tuberculous meningitis (TBM) or cryptococcal meningitis (CM) remains a significant clinical challenge. Neutrophil Gelatinase-Associated Lipocalin (NGAL) has been reported as a novel inflammatory biomarker in the early stages of infection. This study aimed to investigate whether cerebrospinal fluid (CSF) NGAL can serve as a potential biomarker for distinguishing between BM and TBM or CM. METHODS We prospectively enrolled the patients with suspected CNS infections at admission and divided them into three case groups: BM (n = 67), TBM (n = 55), CM (n = 51), and an age- and sex-matched hospitalized control (HC, n = 58). Detected the CSF NGAL and assessed its diagnostic accuracy in distinguishing between BM and TBM or CM. Additionally, longitudinally measured the CSF NGAL levels in patients with BM to evaluate its potential as a monitoring tool for antibacterial treatment. RESULTS The concentration of CSF NGAL in BM was significantly higher than in TBM, CM, and HC (all P < 0.05), while the serum NGAL did not show significant differences among the three case groups. The ROC analysis demonstrated that CSF NGAL presented a good diagnostic performance with an AUC of 0.834 (0.770-0.886) and at the optimal cutoff value of 74.27 ng/mL with 70.15% sensitivity and 77.36% specificity for discriminating BM with TBM and CM. Additionally, the CSF NGAL in the convalescent period of BM was significantly lower than in the acute period (P < 0.05). CONCLUSIONS CSF NGAL may serve as a potential biomarker for distinguishing between acute BM and TBM or CM. Additionally, it holds clinical significance in monitoring the effectiveness of antibiotic therapy for BM.
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Affiliation(s)
- Qi Wang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Qingwen Lin
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Haiyan Wang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Minjie Tang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Kengna Fan
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Zeqin Zhang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Er Huang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Weiqing Zhang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Fengqing Wang
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Qishui Ou
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Xiaofeng Liu
- Department of Laboratory Medicine, Gene Diagnosis Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Key Laboratory of Laboratory Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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27
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Yang J, Wang L, Zhong X, Yang C, Wu Y. Zanubrutinib-induced aseptic meningitis: a case report and literature review. Front Pharmacol 2023; 14:1242491. [PMID: 37727390 PMCID: PMC10505928 DOI: 10.3389/fphar.2023.1242491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Zanubrutinib is a Bruton tyrosine kinase (BTK) inhibitor used in B cell malignancy treatment and is generally well tolerated in most patients. Zanubrutinib-induced aseptic meningitis is currently not reported. Herein, we present the first case of zanubrutinib-induced aseptic meningitis. A 33-year-old woman was diagnosed with relapsed/refractory follicular lymphoma and subsequently developed aseptic meningitis after receiving zanubrutinib treatment. We reviewed the literature and uncovered the lack of current reports on zanubrutinib or other BTK inhibitor-induced aseptic meningitis. Moreover, we summarized cases on aseptic meningitis induced by common chemotherapy and targeted drugs used for hematological diseases. Drug-induced aseptic meningitis (DIAM) is a drug-induced meningeal inflammation. The possible pathogenesis is the direct stimulation of the meninges via intrathecal injection of chemotherapy drugs and immune hypersensitivity response caused by immunosuppressive drugs. It is more common in women with immune deficiency and mainly manifests as persistent headache and fever. Cerebrospinal fluid examinations mainly demonstrate a significant increase in cells and proteins. DIAM diagnosis needs to exclude bacterial, fungal, viral, and tuberculosis infections; neoplastic meningitis; and systemic diseases involving the meninges. The prognosis of DIAM is usually favorable, and physicians should detect and stop the causative drug. In conclusion, zanubrutinib-induced aseptic meningitis is a rare but serious complication, and physicians should be promptly aware of this adverse event to avoid serious consequences.
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Affiliation(s)
- Jinjun Yang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Zhong
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chenlu Yang
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wu
- Department of Hematology and Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
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28
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Saha A, Kanamgode SS, Malempati SC, Chaudhuri S, Scott J. Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis. World J Neurol 2023; 9:37-43. [DOI: 10.5316/wjn.v9.i4.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Meningitis remains a significant source of mortality and morbidity, with an incidence of 1 per 100000 persons in the United States. Guidelines recommend obtaining blood cultures and cerebrospinal fluid (CSF) studies in patients presenting with acute meningitis syndrome, and beginning treatment with broad spectrum antibiotics based on the age and certain predisposing conditions. In some patients however, the diagnostic lumbar puncture (LP) is not performed due to a multitude of reasons, ranging from increased intracranial pressure to failed attempt. In such situations, appropriate therapy is initiated empirically and often continued without establishment of a definitive diagnosis.
AIM To determine whether a diagnostic LP in acute meningitis syndrome was associated with a better outcome and less duration of antibiotic therapy, along with potential causes for deferral of procedure.
METHODS A retrospective study was conducted amongst the patients presenting to a 360 bedded community hospital in central Massachusetts with a diagnosis of acute meningitis syndrome between January 2010 – September 2022. The electronic health records were accessed to collect necessary demographic and clinical data, including etiology of meningitis, lumbar puncture results, reason for procedure deferral, duration of antibiotic therapy and clinical outcome. The patients were subsequently divided into two groups based on whether they received a LP or not, and data was analyzed.
RESULTS A total of 169 patients admitted with acute meningitis syndrome between September 2010-2022 were included in the study. The mean age of the participants was 54.3 years (SD +/- 19.2 years). LP was performed for 130 (76.9%) participants, out of which, 28 (21.5%) showed some growth in CSF culture. The most commonly identified organism was streptococcus pneumoniae. Amongst the 39 patients in whom LP was deferred, the major reasons recorded were: Body habitus (n = 6, 15.4%), and unsuccessful attempt (n = 4, 10.3%). While 93 (71.5%) patients with LP received antibiotic therapy, only 19 (48.7%) patients without LP received the antibiotics, with the principal reason being spontaneous improvement in sensorium without any diagnosed source of infection. The mean duration of antibiotic use was 12.3 days (SD +/- 5.6) in the LP group and 11.5 days (SD +/- 7.0) in the non-LP group (P = 0.56; statistically not significant). We observed higher long term sequalae in the non-LP group (n = 6, 15.4%) compared to the LP group (n = 9, 6.9%). Similarly, the death rate was higher in the non-LP group (n = 7, 18.0%) compared to the LP group (n = 9, 6.9%).
CONCLUSION LP remains the cornerstone for diagnosing meningitis, but often CSF results are unavailable, leading to empiric treatment. Our study identified that body habitus and unsuccessful attempts were the most common reasons for LP not being performed, leading to empiric antibiotic coverage. There was no difference between the duration of antibiotics received by the two groups, but a lower proportion of patients without LP received antibiotics, attributed to a spontaneous improvement in sensorium. However, the residual neurological sequelae and death rates were higher in patients without LP, signifying a potential under-treatment. A LP remains crucial to diagnose meningitis, and a lack of CSF analysis predisposes to under-treatment, leading to higher neurological sequelae and increased chances of death.
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Affiliation(s)
- Arunava Saha
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | | | | | - Sirshendu Chaudhuri
- Assistant Professor, Indian Institute of Public Health, Hyderabad 500030, Telangana, India
| | - Jeffrey Scott
- Department of Pulmonary and Critical Care Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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Weiler NS, Niendorf E, Dumic I. Two Insects, Two Bites, One Patient: A Lyme Disease and Jamestown Canyon Co-infection. Cureus 2023; 15:e40222. [PMID: 37435255 PMCID: PMC10332484 DOI: 10.7759/cureus.40222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Lyme disease (LD) is the most common tick-borne illness across the United States, caused by the bacterium Borrelia burgdorferi sensu lato and transmitted to humans by the bite of infected Ixodes ticks. Jamestown Canyon Virus (JCV) is an emerging mosquito-borne pathogen found mostly in the upper Midwest and Northeastern United States. Co-infection between these two pathogens has not been previously reported since it would require the host to be bitten by the two infected vectors at the same time. We report a 36-year-old man who presented with erythema migrans and meningitis. While erythema migrans is a pathognomonic sign of early localized Lyme disease, Lyme meningitis does not occur in this stage but in the early disseminated stage. Furthermore, CSF tests were not supportive of neuroborreliosis, and the patient was ultimately diagnosed with JCV meningitis. We review JCV infection, LD, and this first reported co-infection to illustrate the complex interaction between different vectors and pathogens and to emphasize the importance of considering co-infection in people who live in vector-endemic areas.
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Affiliation(s)
| | | | - Igor Dumic
- Hospital Medicine, Mayo Clinic, Eau Claire, USA
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30
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Giuliano S, Sbrana F, Tascini C. Review of Progress and Challenges in Bacterial Meningitis. JAMA 2023; 329:1406-1407. [PMID: 37097360 DOI: 10.1001/jama.2023.2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Carlo Tascini
- Department of Medical Area (DAME), University of Udine, Udine, Italy
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31
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Ait-Ali Y, Bourlon L, Jacobs FM. Review of Progress and Challenges in Bacterial Meningitis. JAMA 2023; 329:1406. [PMID: 37097361 DOI: 10.1001/jama.2023.2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Yannis Ait-Ali
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère AP-HP, Clamart, France
| | - Léo Bourlon
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère AP-HP, Clamart, France
| | - Frédéric M Jacobs
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère AP-HP, Clamart, France
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32
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Hasbun R. Review of Progress and Challenges in Bacterial Meningitis-Reply. JAMA 2023; 329:1407. [PMID: 37097358 DOI: 10.1001/jama.2023.2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- Rodrigo Hasbun
- Section of Infectious Diseases, UT Health McGovern Medical School, Houston, Texas
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Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019). Vaccines (Basel) 2023; 11:vaccines11030508. [PMID: 36992092 DOI: 10.3390/vaccines11030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring’s vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring’s vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.
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Error in Box. JAMA 2023; 329:515. [PMID: 36786803 PMCID: PMC9929688 DOI: 10.1001/jama.2023.0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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