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Association of Corticosteroid Treatment With Outcomes in Pediatric Patients With Bacterial Meningitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Ther 2022; 44:551-564. [PMID: 35272859 DOI: 10.1016/j.clinthera.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/30/2022] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Controversy has arisen among the overall benefit and potential risks in the use of corticosteroids for the treatment of pediatric bacterial meningitis. This systematic review and meta-analysis aims to provide evidence of the use of corticosteroids in the treatment of bacterial meningitis in children. METHODS Electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and other databases) were searched from inception until March 9, 2021. Randomized clinical trials focused on corticosteroids as adjuvant therapy in pediatric bacterial meningitis were considered eligible. The primary outcomes were hearing loss and neurologic sequelae. Secondary outcomes were mean days before resolution of fever, mortality, secondary fever, and reactive arthritis. Fixed- or random-effects models were used to evaluate the association between corticosteroids therapy and outcomes by calculating risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data extraction, and risk assessment. FINDINGS Twenty-nine studies with 3433 patients were included. An obvious benefit was found in the treatment of corticosteroids in hearing loss (RR = 0.62; 95% CI, 0.47-0.81; I² = 17%; P = 0.0006). No benefit was found in the rate of neurologic sequelae. However, obvious benefit was found in the low-dosage subgroup (0.6 mg/kg per day) (RR = 0.60; 95% CI, 0.47-0.77; I² = 0%; P < 0.0001) but not in the high-dosage subgroup (0.8 mg/kg per day). An increasing rate of secondary fever was found when using corticosteroids (RR = 1.29; 95% CI, 1.10-1.51; I² = 13%; P = 0.001). Corticosteroids could significantly decrease the mean days before resolution of fever (MD = -1.48; 95% CI, -1.79 to -1.17; I² = 84%, P < 0.00001). No difference was found in the rate of mortality and reactive arthritis. IMPLICATIONS The findings of this study suggest that the administration of corticosteroids is associated with reduced hearing loss and neurologic sequelae especially in children using a low dose of corticosteroids. Benefits also included a reduction in the mean number of days before resolution of fever.
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Farfán-Albarracín JD, Camacho-Moreno G, Leal AL, Patiño J, Coronell W, Gutiérrez IF, Beltrán S, Álvarez-Olmos MI, Mariño C, Barrero R, Rojas JP, Espinosa F, Arango-Ferreira C, Suarez MA, Trujillo M, López-Medina E, López P, Pinzón H, Ramos N, Moreno VM, Montañez A. Changes in the incidence of acute bacterial meningitis caused by Streptococcus pneumoniae and the implications of serotype replacement in children in Colombia after mass vaccination with PCV10. Front Pediatr 2022; 10:1006887. [PMID: 36210950 PMCID: PMC9545348 DOI: 10.3389/fped.2022.1006887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Acute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia. METHODS This multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008-2011, 2012-2015, and 2016-2019. RESULTS Of the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%. CONCLUSIONS ABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.
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Affiliation(s)
- Juan David Farfán-Albarracín
- Red Neumocolombia, Bogotá, Colombia.,Departamento de Pediatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,HOMI-Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Germán Camacho-Moreno
- Red Neumocolombia, Bogotá, Colombia.,Departamento de Pediatría, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,HOMI-Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia.,Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Aura Lucia Leal
- Red Neumocolombia, Bogotá, Colombia.,Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO), Bogotá, Colombia
| | - Jaime Patiño
- Red Neumocolombia, Bogotá, Colombia.,Fundación Valle de Lili, Cali, Colombia
| | - Wilfrido Coronell
- Red Neumocolombia, Bogotá, Colombia.,Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
| | - Iván Felipe Gutiérrez
- Red Neumocolombia, Bogotá, Colombia.,Clínica Infantil Colsubsidio, Bogotá, Colombia.,Clínica Infantil Santa María del Lago-Colsánitas, Bogotá, Colombia
| | - Sandra Beltrán
- Red Neumocolombia, Bogotá, Colombia.,Clínica Universitaria Colombia-Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | - Martha I Álvarez-Olmos
- Red Neumocolombia, Bogotá, Colombia.,Grupo para el Control de la Resistencia Bacteriana en Bogotá (GREBO), Bogotá, Colombia.,Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Cristina Mariño
- Red Neumocolombia, Bogotá, Colombia.,Hospital Militar Central, Bogotá, Colombia
| | - Rocio Barrero
- Red Neumocolombia, Bogotá, Colombia.,Hospital Universitario Clínica San Rafael, Bogotá, Colombia.,Unidad de Servicios de Salud Santa Clara, Subred Centro Oriente, Bogotá, Colombia
| | - Juan Pablo Rojas
- Red Neumocolombia, Bogotá, Colombia.,Fundación Clínica Infantil Club Noel, Cali, Colombia.,Facultad de Ciencias de la Salud, Universidad Libre Seccional Cali, Cali, Colombia.,Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Bogotá, Colombia.,Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Catalina Arango-Ferreira
- Red Neumocolombia, Bogotá, Colombia.,Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Maria Alejandra Suarez
- Red Neumocolombia, Bogotá, Colombia.,Unidad de Servicio de Salud Tunal, Bogotá, Colombia
| | - Monica Trujillo
- Red Neumocolombia, Bogotá, Colombia.,Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | - Pio López
- Red Neumocolombia, Bogotá, Colombia.,Hospital Universitario del Valle, Cali, Colombia
| | - Hernando Pinzón
- Red Neumocolombia, Bogotá, Colombia.,Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
| | - Nicolás Ramos
- Red Neumocolombia, Bogotá, Colombia.,Los COBOS Medical Center, Bogotá, Colombia
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Hsieh DY, Lai YR, Lien CY, Chang WN, Huang CC, Cheng BC, Kung CT, Lu CH. Nationwide Population-Based Epidemiological Study for Outcomes of Adjunctive Steroid Therapy in Pediatric Patients with Bacterial Meningitis in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126386. [PMID: 34204785 PMCID: PMC8296207 DOI: 10.3390/ijerph18126386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.
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Affiliation(s)
- Dong-Yi Hsieh
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chia-Yi Lien
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Wen-Neng Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Ben-Chung Cheng
- Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence:
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Vahl JM, Goldberg-Bockhorn E, Hoffmann TK, Wigand MC. [Hormonal influence on hearing]. HNO 2021; 69:987-995. [PMID: 33725160 DOI: 10.1007/s00106-021-01019-y] [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: 01/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hearing loss leads to impairments in communication, social interactions, and cognitive functions. This renders early treatment particularly important. A causal therapy is not yet available. Human and animal studies have shown that certain hormones can have a positive effect on hearing. OBJECTIVE This review provides an overview of the effects of various hormones on hearing and describes the potential benefit for future therapeutic approaches. MATERIALS AND METHODS A systematic literature review of reviews dealing with the effects of various hormones on hearing in humans and animals published in PubMed between 2015 and 2020 was conducted. RESULTS Hormones may mediate antiapoptotic effects on structure-relevant cells of the cochlea and auditory pathway, and may influence hair cell functionality or the electrolyte balance of the endo- and perilymph. Current research focuses on glucocorticoids; the mineral corticoid aldosterone; the sex hormones estrogen, progesterone, and testosterone; the growth hormones GH (growth hormone) and IGF‑1 (insulin-like growth factor 1); thyroid hormones; and insulin. Study results are still inconsistent at this time, but various hormones appear to represent a possible future treatment option for acute hearing loss. Long-term hormone treatment, which would be necessary particularly in the case of age-related hearing loss, does not currently represent a sensible course of action due to the side effect profile of the systemic treatment/lack of practicable topical application options. CONCLUSION The mode of action of hormones is complex. Whether they can be used in the future for individualized treatment of patients with acute hearing impairment requires further investigation.
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Affiliation(s)
- J M Vahl
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89070, Ulm, Deutschland.
| | - E Goldberg-Bockhorn
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89070, Ulm, Deutschland
| | - T K Hoffmann
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89070, Ulm, Deutschland
| | - M C Wigand
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89070, Ulm, Deutschland
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King KA, Ansari G, Panackal AA, Zalewski C, Anjum S, Bennett JE, Beri A, Kim HJ, Hammoud D, Brewer CC, Williamson PR. Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients. Otol Neurotol 2019; 40:e657-e664. [PMID: 31157723 PMCID: PMC6565454 DOI: 10.1097/mao.0000000000002242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM). STUDY DESIGN Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM. SETTING Tertiary referral center, National Institutes of Health Clinical Center. PATIENTS Previously healthy adult patients with CM without immune suppressive therapy before disease onset. INTERVENTIONS Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment. RESULTS Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count. CONCLUSIONS Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.
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Affiliation(s)
- Kelly A King
- National Institute on Deafness and Other Communication Disorders
| | | | - Anil A Panackal
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Chris Zalewski
- National Institute on Deafness and Other Communication Disorders
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
| | - Andrea Beri
- Biomedical Translational Research Information System
| | - Hung Jeff Kim
- National Institute on Deafness and Other Communication Disorders
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC
| | - Dima Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Carmen C Brewer
- National Institute on Deafness and Other Communication Disorders
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
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Dexamethasone does not prevent hydrocephalus after severe intraventricular hemorrhage in newborn rats. PLoS One 2018; 13:e0206306. [PMID: 30359428 PMCID: PMC6201923 DOI: 10.1371/journal.pone.0206306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/10/2018] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was done to determine whether dexamethasone treatment prevents posthemorrhagic hydrocephalus (PHH) development and attenuates brain damage after severe IVH in newborn rats. Severe IVH was induced by injecting; 100 μL of blood into each lateral ventricle of postnatal day 4 (P4) Sprague-Dawley rats. Dexamethasone was injected intraperitoneally into rat pups at a dose of 0.5 mg/kg, 0.3 mg/kg, and 0.1 mg/kg on P5, P6, and P7, respectively. Serial brain magnetic resonance imaging and behavioral function tests, such as the negative geotaxis test and the rotarod test, were performed. On P32, brain tissues were obtained for histological and biochemical analyses. Dexamethasone treatment significantly improved the severe IVH-induced increase in the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling-positive cells, glial fibrillary acidic protein-positive astrocytes and ED-1 positive microglia, and the decrease in myelin basic protein. IVH reduced a survival of 71%, that showed a tendency to improve to 86% with dexamethasone treatment, although the result was not statistically significant. However, dexamethasone failed to prevent the progression to PHH and did not significantly improve impaired behavioral tests. Similarly, dexamethasone did not decrease the level of inflammatory cytokines such as interleukin (IL) -1α and ß, IL-6, and tumor necrosis factor-α after severe IVH. Despite its some neuroprotective effects, dexamethasone failed to improve the progress of PHH and impaired behavioral tests after severe IVH.
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