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You JY, Modabber M, Iorio MD, Toffoli D. Ophthalmic Diseases in Meningitis Within the Pediatric Population. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00361-7. [PMID: 38036046 DOI: 10.1016/j.jcjo.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/02/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Meningitis may lead to ophthalmic complications in pediatric populations. The visual aftermath in developed countries has been poorly studied. This study aims to highlight the potential ocular and neuro-ophthalmic sequela of meningitis in the pediatric population of a tertiary pediatric hospital. DESIGN A retrospective chart review of all pediatric patients, between 2006 and 2015, diagnosed with meningitis at the Montreal Children's Hospital was conducted. Study approval was obtained by the Institutional Review Board of the McGill University Health Centre and adhered to the tenets of the Declaration of Helsinki. METHODS Records of all pediatric meningitis patients were extracted and further refined by isolating all who received an ophthalmology consultation. Relevant demographic data, general medical information, ocular findings, and imaging results were extracted. The proportion of ocular abnormalities was calculated and analyzed. RESULTS Seventy-two of 861 meningitis patients (8.4%) received an ophthalmology consultation. Forty-six patients met the inclusion criteria, and 31 of those (67.4%) demonstrated ocular abnormalities. Children presented most frequently with abnormalities involving visual acuity (8 of 32), extraocular movements and alignment (14 of 28), optic nerve (10 of 41), pupillary reactivity (4 of 35), and periorbital/orbital cellulitis (4 of 46). Older patients were more likely to have ophthalmologic findings. CONCLUSION This chart review highlights the ocular abnormalities found in children who suffer from meningitis and present to a tertiary-care centre in a high sociodemographic index country. Complications may be lasting. Treating ophthalmologists should be cognizant of potential ocular abnormalities among meningitis patients. We advocate for increased awareness of this association among health care providers.
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Affiliation(s)
- Jia Yue You
- Departments of Ophthalmology and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Que.
| | | | - Massimo Di Iorio
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ont
| | - Daniela Toffoli
- Departments of Ophthalmology and Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Que; Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Que
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Paireau J, Chen A, Broutin H, Grenfell B, Basta NE. Seasonal dynamics of bacterial meningitis: a time-series analysis. LANCET GLOBAL HEALTH 2017; 4:e370-7. [PMID: 27198841 PMCID: PMC5516123 DOI: 10.1016/s2214-109x(16)30064-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 12/19/2022]
Abstract
Background Bacterial meningitis, which is caused mainly by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, inflicts a substantial burden of disease worldwide. Yet, the temporal dynamics of this disease are poorly characterised and many questions remain about the ecology of the disease. We aimed to comprehensively assess seasonal trends in bacterial meningitis on a global scale. Methods We developed the first bacterial meningitis global database by compiling monthly incidence data as reported by country-level surveillance systems. Using country-level wavelet analysis, we identified whether a 12 month periodic component (annual seasonality) was detected in time-series that had at least 5 years of data with at least 40 cases reported per year. We estimated the mean timing of disease activity by computing the centre of gravity of the distribution of cases and investigated whether synchrony exists between the three pathogens responsible for most cases of bacterial meningitis. Findings We used country-level data from 66 countries, including from 47 countries outside the meningitis belt in sub-Saharan Africa. A persistent seasonality was detected in 49 (96%) of the 51 time-series from 38 countries eligible for inclusion in the wavelet analyses. The mean timing of disease activity had a latitudinal trend, with bacterial meningitis seasons peaking during the winter months in countries in both the northern and southern hemispheres. The three pathogens shared similar seasonality, but time-shifts differed slightly by country. Interpretation Our findings provide key insight into the seasonal dynamics of bacterial meningitis and add to knowledge about the global epidemiology of meningitis and the host, environment, and pathogen characteristics driving these patterns. Comprehensive understanding of global seasonal trends in meningitis could be used to design more effective prevention and control strategies. Funding Princeton University Health Grand Challenge, US National Institutes of Health (NIH), NIH Fogarty International Center Research and Policy for Infectious Disease Dynamics programme (RAPIDD), Bill & Melinda Gates Foundation.
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Affiliation(s)
- Juliette Paireau
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA; Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
| | - Angelica Chen
- Department of Computer Science, Princeton University, Princeton, NJ, USA
| | - Helene Broutin
- MIVEGEC (Mixed Research Group CNRS 5290/IRD 224/University of Montpellier), Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Pharmacie et Odontologie, University Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Bryan Grenfell
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Nicole E Basta
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Muciño-Ortega E, Mould-Quevedo JF, Farkouh R, Strutton D. [Economic evaluation of an infant immunization program in Mexico, based on 13-valent pneumococcal conjugated vaccines]. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S65-S70. [PMID: 21839902 DOI: 10.1016/j.jval.2011.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV's) currently available in Mexico from a third payer perspective. MATERIAL AND METHODS A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children <2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV's. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY's) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed. RESULTS Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY's and 332.006 QALY's and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV's prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY's, 282.969 and 114.972 QALY's and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine. CONCLUSIONS In Mexico, immunization strategies based on 7, 10 and 13-valent PCV's would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV's.
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Memish ZA, El-Saed A, Al-Otaibi B, Shaalan MA, Alola SA, Thaqafi AO. Epidemiology of invasive pneumococcal infection in children aged five years and under in Saudi Arabia: a five-year retrospective surveillance study. Int J Infect Dis 2010; 14:e708-12. [PMID: 20627645 DOI: 10.1016/j.ijid.2010.02.2242] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 11/16/2009] [Accepted: 02/01/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The epidemiology of invasive pneumococcal disease (IPD) in children aged <or=5 years in Saudi Arabia has not been described. We conducted a retrospective surveillance study to describe the epidemiology of IPD in the population of children aged <or=5 years served by the National Guard Health Affairs hospitals in central and western regions of Saudi Arabia. METHODS We reviewed the medical records of children <or=5 years old admitted to the King Abdulaziz Medical City hospitals in Riyadh and Jeddah with pneumococcal infections for the period January 1999 through December 2003. Only microbiologically confirmed IPD cases (meningitis or bacteremia) were included in the analysis. RESULTS A total of 82 IPD cases, 19 (23.2%) meningitis and 63 (76.8%) bacteremia, were diagnosed during the five-year period. Of these, 12.2% (10/82) died, with a case-fatality slightly but insignificantly higher in cases of meningitis (15.8%) than bacteremia (11.1%). The average annual IPD incidence was 17.4 per 100,000 (4.0 for meningitis and 13.4 for bacteremia). The incidence was roughly similar in males and females (18.3 and 16.6, respectively; p=0.663) and was almost 4-fold higher in the first year of life compared to the next four years (40.6 and 11.5, respectively; p<0.001). The average annual IPD mortality was 2.1 per 100,000 and was higher in the first year of life compared to the next four years (5.2 and 1.3 , respectively; p=0.043). CONCLUSIONS In the pre-vaccination era (1999-2003) in Saudi Arabia, IPD incidence was comparable to the pre-vaccination incidence rates from many industrialized countries, with children aged <or=1 year suffering the highest IPD risk among those aged <or=5 years.
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Affiliation(s)
- Ziad A Memish
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23:467-92. [PMID: 20610819 PMCID: PMC2901656 DOI: 10.1128/cmr.00070-09] [Citation(s) in RCA: 511] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.
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Affiliation(s)
- Matthijs C. Brouwer
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
| | - Allan R. Tunkel
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
| | - Diederik van de Beek
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
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Jit M. The risk of sequelae due to pneumococcal meningitis in high-income countries: a systematic review and meta-analysis. J Infect 2010; 61:114-24. [PMID: 20433866 DOI: 10.1016/j.jinf.2010.04.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/21/2010] [Accepted: 04/21/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the risk of various kinds of sequelae in survivors of meningitis due to Streptococcus pneumoniae, as well as the influence of co-factors such as study design, study population and treatment on this risk. METHODS MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 September 1991 to 18 June 2009 for original articles on pneumococcal meningitis sequelae. Prevalence of sequelae was pooled using random effects meta-analysis. Studies were appraised for the influence of referral bias, external validity of study populations, testing procedure and publication bias. RESULTS Data were extracted from 63 studies involving 3408 pneumococcal meningitis survivors. The pooled prevalence of any reported sequelae from 48 studies was 31.7% (95% confidence interval 27.2-36.3%) using a random effects model (Cochran-Q = 277, p < 0.01). Differences in studies due to design, study population and treatment were not significant. The pooled prevalence of hearing loss, seizures, hydrocephalus, spasticity/paresis, cranial nerve palsies and visual impairment was 20.9% (17.1-24.7%), 6.5% (3.3-9.7%), 6.8% (3.3-10.2%), 8.7% (6.4-11.0%), 12.2% (5.3-19.1%) and 2.4% (0-5.7%) respectively. CONCLUSIONS The burden of sequelae due to pneumococcal meningitis remains high in the reviewed studies.
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Affiliation(s)
- Mark Jit
- Modelling and Economics Unit, Health Protection Agency Centre for Infections, London, UK.
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Wilms H, Schwark T, Brandenburg LO, Sievers J, Dengler R, Deuschl G, Lucius R. Regulation of activin A synthesis in microglial cells: Pathophysiological implications for bacterial meningitis. J Neurosci Res 2010; 88:16-23. [DOI: 10.1002/jnr.22185] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Serious neurologic sequelae in cases of meningitis arising from infection by conjugate vaccine-related and nonvaccine-related serogroups of Streptococcus pneumoniae. Pediatr Infect Dis J 2008; 27:771-5. [PMID: 18679153 DOI: 10.1097/inf.0b013e3181710976] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Introduction of the heptavalent conjugate vaccine for Streptococcus pneumoniae (PCV7) has led to a dramatic decline in meningitis by PCV7 serotypes, raising the possibility of similar trends by PCV7-related serogroups through cross-protection. A present concern, however, is of serotype replacement by pneumococci not related to PCV7 serogroups. If this occurs, there are currently few data to predict whether clinical outcomes will change substantially. METHODS To address these questions, we analyzed medical records of 86 cases of pneumococcal meningitis treated at Nationwide Children's Hospital (1993-2004). Adverse neurologic sequelae and death were compared between cases with cerebrospinal fluid isolates characterized as vaccine-related serogroups-serotypes belonging to PCV7 or related to PCV7 serogroups, and those designated nonvaccine serogroups-serotypes neither belonging to PCV7 nor related to PCV7 serogroups. Serotype 19A, because of recent reports of increased incidence, was subanalyzed separately. RESULTS Thirty-six of 86 (42%) subjects had serious complications, including 6 who died. All 6 deaths occurred in patients with vaccine-related serogroups. Deafness was the most common complication, occurring in 26 (32.5%) survivors. There was no difference in the frequency of total complications between PCV7-related and non-PCV7 groups: 5 of 12 (42%) for non-PCV7 serogroups versus 31 of 74 (42%) for PCV-related serogroups (OR: 1.0; 95% CI: 0.2-4.0). Serious outcomes occurred in 3 of 4 cases due to serogroup 19A. Non-PCV7 serogroups increased slightly at the end of the study period. CONCLUSIONS In children with pneumococcal meningitis, infections with non-PCV7 serogroups seem less likely to result in death. Among survivors, there is preliminary evidence of parity in neurologic sequelae between PCV7 and non-PCV7 serogroups.
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Pneumococcal meningitis in the era of pneumococcal conjugate vaccine implementation. Eur J Clin Microbiol Infect Dis 2007; 27:191-9. [DOI: 10.1007/s10096-007-0417-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
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Brink M, Hagberg L. Outcome of 8-hour dosing intervals with beta-lactam antibiotics in adult acute bacterial meningitis. ACTA ACUST UNITED AC 2006; 38:772-7. [PMID: 16938730 DOI: 10.1080/00365540600643229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The outcome of dosing with beta-lactam antibiotics at 8-h intervals for adult patients with community-acquired acute bacterial meningitis was retrospectively analysed at Sahlgrenska University Hospital, Gothenburg, Sweden. 80 medical records were identified for a 6-y period from 1999 to 2004. The most common pathogens noted were Streptococcus pneumoniae (47.5%), Neiseria meningitidis (12.5%), and Listeria monocytogenes (5.0%). Other bacteria were diagnosed in 16.3% of all episodes, but the bacteriological aetiology remained unknown in 18.8%. 79 episodes of bacterial meningitis were treated with beta-lactam antibiotics at 8-h dosing intervals. The mortality rate in these patients was 6.3%, with an incidence of permanent neurological deficiencies of 24.1%. Our study shows that a low mortality rate can be achieved using beta-lactam antibiotics at longer dosing intervals than usually recommended by international guidelines.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Community-Acquired Infections/complications
- Community-Acquired Infections/drug therapy
- Community-Acquired Infections/mortality
- Drug Administration Schedule
- Female
- Humans
- Male
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/drug therapy
- Meningitis, Bacterial/mortality
- Meningitis, Listeria/complications
- Meningitis, Listeria/drug therapy
- Meningitis, Listeria/mortality
- Meningitis, Meningococcal/complications
- Meningitis, Meningococcal/drug therapy
- Meningitis, Meningococcal/mortality
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/drug therapy
- Meningitis, Pneumococcal/mortality
- Middle Aged
- Retrospective Studies
- Treatment Outcome
- beta-Lactams/administration & dosage
- beta-Lactams/therapeutic use
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Affiliation(s)
- Magnus Brink
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
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