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Ranzenigo M, van Soest TM, Hensen EF, Cinque P, Castagna A, Brouwer MC, van de Beek D. Otitis in Patients With Community-Acquired Bacterial Meningitis: A Nationwide Prospective Cohort Study. Clin Infect Dis 2024; 79:329-335. [PMID: 38655694 PMCID: PMC11327785 DOI: 10.1093/cid/ciae221] [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: 01/04/2024] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Otitis is commonly associated with community-acquired bacterial meningitis, but the role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis. METHODS We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 and July 2021. RESULTS A total of 2548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%), and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% confidence interval [CI] .59-.92; P = .008). There was no association between outcome and ear surgery. CONCLUSIONS Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.
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Affiliation(s)
- Martina Ranzenigo
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Thijs M van Soest
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head and Neck Surgery, LUMC, Leiden, The Netherlands
| | - Paola Cinque
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
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Zachariassen M, Thomsen MM, Hillig T, Trier-Petersen P, Jensen AV, Friis-Hansen LJ, Brandt CT. Tenascin-C in patients with central nervous system infections. J Neuroimmunol 2024; 392:578373. [PMID: 38776710 DOI: 10.1016/j.jneuroim.2024.578373] [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: 11/02/2023] [Revised: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The extracellular matrix protein tenascin-C has been discovered to be an important regulator of the response to tissue injury and repair in cerebrovascular diseases. This study investigated if tenascin-C is released in response to infections in the central nervous system (CNS). METHODS Tenascin-C concentration in the cerebrospinal fluid (CSF) was measured in patients, (>18 years) with and without CNS infections, admitted to a department of infectious diseases in Denmark. CSF tenascin-C was measured on the Meso-scale platform. RESULTS 174 patients were included of which 140 were diagnosed with a CNS infection and 34 where this was ruled out (control group). Median CSF tenascin-C levels were significantly higher among patients with bacterial meningitis (147 pg/mL), viral meningitis (33 mg/mL), viral encephalitis (39 pg/mL) and Lyme neuroborreliosis (45 pg/mL) when compared to controls (21 pg/mL). Correlations between tenascin-C and CSF markers of inflammation and age were only moderate. CONCLUSION Levels of CSF tenascin-C are higher among patients with bacterial and viral neuroinfections, already on admission, but exhibit only a modest correlation with baseline indices of neuroinflammation. CSF tenascin-C is highest among patients with bacterial meningitis compared to the other CNS infections. Patients with unfavorable outcomes presented with higher median CSF tenascin-C than their counterparts.
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Affiliation(s)
- Morten Zachariassen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
| | - Martin Munthe Thomsen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Pelle Trier-Petersen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Andreas Vestergaard Jensen
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University Hospital Copenhagen, Hillerød, Denmark
| | - Lennart Jan Friis-Hansen
- Department of Clinical Microbiology, University Hospital Rigshospitalet, University of Copenhagen, Denmark
| | - Christian Thomas Brandt
- Department of Infectious Diseases, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Region, Copenhagen, Denmark
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Dulin M, Chevret S, Salmona M, Jacquier H, Bercot B, Molina JM, Lebeaux D, Munier AL. New Insights Into the Therapeutic Management of Varicella Zoster Virus Meningitis: A Series of 123 Polymerase Chain Reaction-Confirmed Cases. Open Forum Infect Dis 2024; 11:ofae340. [PMID: 38957692 PMCID: PMC11218771 DOI: 10.1093/ofid/ofae340] [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: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
Background Varicella zoster virus (VZV) can reactivate and cause meningitis, but few studies have distinguished it from meningoencephalitis regarding treatment recommendations.The objective of this study was to assess the outcomes of a large series of patients with VZV meningitis according to their therapeutic management. Methods We conducted a bicentric retrospective cohort study, in Paris, France, including all adult patients with a cerebrospinal fluid sample positive for VZV by polymerase chain reaction between April 2014 and June 2022. We distinguished meningitis from encephalitis according to the International Encephalitis Consortium criteria. Unfavorable outcome was defined as mortality or functional sequelae defined by a loss of 2 points on the modified Rankin Scale. Results We included 123 patients with meningitis. Among them, 14% received no antivirals, while 20% were treated with oral valacyclovir alone, 41% with a short course of intravenous (IV) acyclovir before switch to valacyclovir, and 25% with a long course of IV acyclovir. Outcomes were favorable regardless of antiviral regimen. In multivariate analysis, only age, underlying immunosuppression, and cranial radiculitis appear to be predictive factors for longer IV therapy, based on the Akaike information criterion. Conclusions In this study, patients with VZV meningitis had a good outcome, with no evidence of any impact of the treatment strategy. However, further studies are needed to support the possibility of milder treatment in immunocompetent patients, avoiding cost and side effects of IV acyclovir.
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Affiliation(s)
- Marie Dulin
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sylvie Chevret
- Biostatistics Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Maud Salmona
- Laboratory of Virology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Hervé Jacquier
- Laboratory of Microbiology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Béatrice Bercot
- Laboratory of Microbiology, Saint Louis-Lariboisière-Fernand-Widal Hospital Group, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - David Lebeaux
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne-Lise Munier
- Department of Infectious Diseases, Saint Louis-Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Olie SE, Staal SL, Ter Horst L, van Zeggeren IE, Man WK, Tanck MWT, van de Beek D, Brouwer MC. Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections. J Infect 2024; 88:106117. [PMID: 38320644 PMCID: PMC10943182 DOI: 10.1016/j.jinf.2024.01.016] [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: 09/15/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES We aimed to determine diagnostic accuracy of inflammatory markers in plasma and cerebrospinal fluid (CSF) for the diagnosis of central nervous system (CNS) infections and specifically bacterial meningitis. METHODS We analyzed 12 cytokines, chemokines, and acute phase reactants in CSF and plasma of 738 patients with suspected neurological infection included in a multicenter prospective cohort. We determined diagnostic accuracy for predicting any CNS infection and bacterial meningitis. RESULTS We included 738 episodes between 2017 and 2022, split into a derivation (n = 450) and validation cohort (n = 288). Of these patients, 224 (30%) were diagnosed with CNS infection, of which 81 (11%) with bacterial meningitis, 107 (14%) with viral meningitis or encephalitis, and 35 patients (5%) with another CNS infection. Diagnostic accuracy of CRP, IL-6, and Il-1β in CSF was high, especially for diagnosing bacterial meningitis. Combining these biomarkers in a multivariable model increased accuracy and provided excellent discrimination between bacterial meningitis and all other disorders (AUC = 0.99), outperforming all individual biomarkers as well as CSF leukocytes (AUC = 0.97). When applied to the population of patients with a CSF leukocyte count of 5-1000 cells/mm3, accuracy of the model also provided a high diagnostic accuracy (AUC model = 0.97 vs. AUC CSF leukocytes = 0.80) with 100% sensitivity and 92% specificity. These results remained robust in a temporal validation cohort. CONCLUSIONS Inflammatory biomarkers in CSF are able to differentiate CNS infections and especially bacterial meningitis from other disorders. When these biomarkers are combined, their diagnostic accuracy exceeds that of CSF leukocytes alone and as such these markers have added value to current clinical practice.
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Affiliation(s)
- Sabine E Olie
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Steven L Staal
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Liora Ter Horst
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ingeborg E van Zeggeren
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wing K Man
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Michael W T Tanck
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
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van Zeggeren IE, Pennartz CJ, Ter Horst L, van de Beek D, Brouwer MC. Diagnostic accuracy of clinical and laboratory characteristics in suspected non-surgical nosocomial central nervous system infections. J Hosp Infect 2024; 145:99-105. [PMID: 38219837 DOI: 10.1016/j.jhin.2023.12.015] [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: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The diagnosis of meningitis in non-surgical hospitalized patients is often difficult and diagnostic accuracy of clinical, laboratory, and radiological characteristics is unknown. AIM To assess diagnostic accuracy for individual clinical characteristics of patients suspected of non-surgical nosocomial central nervous system (CNS) infections. METHODS In a prospective multi-centre cohort study in the Netherlands with adults suspected of CNS infections, consecutive patients who underwent a lumbar puncture for the suspicion of a non-surgical nosocomial CNS infection were included. All episodes were categorized into five final clinical diagnosis categories, as reference standard: CNS infection, CNS inflammatory disease, systemic infection, other neurological disease, or non-systemic, non-neurological disease. FINDINGS Between 2012 and 2022, 114 out of 1275 (9%) patients included in the cohort had suspected non-surgical nosocomial CNS infection: 16 (14%) had a confirmed diagnosis, including four (25%) with bacterial meningitis, nine (56%) with viral CNS infections, two (13%) fungal meningitis, and one (6%) parasitic meningitis. Diagnostic accuracy of individual clinical characteristics was generally low. Elevated CSF leucocyte count had the highest sensitivity (81%; 95% confidence interval (CI): 54-96) and negative predictive value (NPV) (96%; 95% CI: 90-99). When combining the presence of abnormalities in neurological or CSF examination, sensitivity for diagnosing a CNS infection was 100% (95% CI: 79-100) and NPV 100% (95% CI: 78-100). CSF examination changed clinical management in 47% of patients. CONCLUSION Diagnostic accuracy for individual clinical characteristics was low, with elevated CSF leucocyte count having the highest sensitivity and NPV.
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Affiliation(s)
- I E van Zeggeren
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - C J Pennartz
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - L Ter Horst
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - D van de Beek
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands
| | - M C Brouwer
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands.
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Someko H, Okazaki Y, Tsujimoto Y, Ishikane M, Kubo K, Kakehashi T. Diagnostic accuracy of rapid antigen tests in cerebrospinal fluid for pneumococcal meningitis: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:310-319. [PMID: 36503113 DOI: 10.1016/j.cmi.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately. OBJECTIVES To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis. METHODS Data sourcesCochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteriaAll types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. ParticipantsPatients with suspected meningitis. TestsRapid antigen tests in CSF. Reference standardsOne or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of biasThe methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesisWe used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture. RESULTS Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4-100%) and 98.2% (95% CI, 96.9-98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6-79.9%) and 100% (95% CI, 99.7-100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries. CONCLUSIONS Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests.
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Affiliation(s)
- Hidehiro Someko
- Department of General Internal Medicine, Asahi General Hospital, Asahi, Japan.
| | - Yuji Okazaki
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yasushi Tsujimoto
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan; Department of Health Promotion and Human Behavior, Kyoto University Graduate, School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kenji Kubo
- Department of Infectious Diseases and Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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van Soest TM, Søndermølle MB, Brouwer MC, Chekrouni N, Larsen AR, Petersen A, van Sorge NM, Nielsen H, van de Beek D, Bodilsen J. Community-acquired Staphylococcus aureus meningitis in adults. J Infect 2023; 86:239-244. [PMID: 36682629 DOI: 10.1016/j.jinf.2023.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease. METHODS We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics. RESULTS We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score <14), and fever was present in only 18 of 108 patients (17%). Surgery was performed in 14 of 33 patients (42%) with spondylodiscitis and 26 of 52 (50%) with endocarditis. A favorable outcome (Glasgow Outcome Scale score 5) occurred in 26 of 111 patients (23%), while 39 (35%) died. The most common bacterial clonal complexes (CC) were CC30 (16 [17%]), CC45 (16 [17%]), CC5 (12 [13%], and CC15 (10 [11%]); no associations between CCs and concomitant foci or outcome were found. CONCLUSIONS Community-acquired S. aureus meningitis is a severe disease with a high case fatality rate, occurring mainly in patients with concomitant endocarditis or spondylodiscitis.
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Affiliation(s)
- Thijs M van Soest
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Maria Birgitte Søndermølle
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Nora Chekrouni
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | | | | | - Nina M van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Henrik Nielsen
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neurosciences, Neuroinfection and - Inflammation, Amsterdam, the Netherlands; European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
| | - Jacob Bodilsen
- European Society for Clinical Microbiology and Infectious Disease (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark.
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van Soest TM, Horst LT, Chekrouni N, Bijlsma MW, Brouwer MC, Portillo DU, van de Beek D, Hasbun R. A risk score for identifying patients at a low risk of bacterial meningitis amongst adults with cerebrospinal fluid leucocytosis and a negative gram stain result: a derivation and validation study. Clin Microbiol Infect 2023; 29:360-365. [PMID: 36220627 DOI: 10.1016/j.cmi.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to derive and validate a risk score to differentiate patients with bacterial meningitis from those with viral meningitis or encephalitis amongst patients presenting with cerebrospinal fluid (CSF) leucocytosis and a negative Gram staining result. METHODS We included adults with bacterial and viral meningitis or encephalitis presenting with CSF leukocyte counts of >10 per mm3 and a negative Gram staining result from cohorts in Houston, Texas (2004-2019), and the Netherlands (2012-2021). Derivation and the first validation were performed in the American patients and further validation in the Dutch patients. RESULTS Derivation was performed in 109 American patients with bacterial meningitis (median age, 56 years; interquartile range [IQR], 46-66 years; 46% women) and 194 with viral meningitis or encephalitis (median age, 46 years; IQR, 33-60 years; 53% women). Serum leukocyte counts of >10.0 × 109/L, CSF leukocyte counts of >2000 per mm3, granulocyte counts of >1180 per mm3, protein levels of >2.2 g/L, glucose levels of <1.9 mmol/L and fever on admission were included in the risk score, which was dichotomized into 'low risk' (0 present) and 'high risk' (>0 present). The first validation showed a sensitivity of 100% (95% CI, 96.6-100) and specificity of 34.0% (95% CI, 27.4-41.2). Further validation in 262 Dutch patients with bacterial meningitis (median age, 57 years; IQR 44-70 years; 45% women) and 68 with viral meningitis (median age, 34 years; IQR, 28-45 years; 60% women) showed a sensitivity of 99.6% (95% CI, 97.9-100) and specificity of 41.2% (95% CI, 29.4-53.7). CONCLUSIONS Our risk score may be able to rule out bacterial meningitis amongst patients presenting with CSF leucocytosis and a negative Gram staining result. However, it needs prospective testing prior to clinical implementation.
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Affiliation(s)
- Thijs M van Soest
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Liora Ter Horst
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Nora Chekrouni
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Merijn W Bijlsma
- Amsterdam UMC, Department of Pediatrics, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniela Urueta Portillo
- Department of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, University of Amsterdam, Amsterdam, the Netherlands
| | - Rodrigo Hasbun
- Department of Internal Medicine, University of Texas Health McGovern Medical School, Houston, TX, USA.
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Inborn Errors of Immunity Predisposing to Herpes Simplex Virus Infections of the Central Nervous System. Pathogens 2023; 12:pathogens12020310. [PMID: 36839582 PMCID: PMC9961685 DOI: 10.3390/pathogens12020310] [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: 01/26/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Herpesvirus infections can lead to a number of severe clinical manifestations, particularly when involving the central nervous system (CNS), causing encephalitis and meningitis. However, understanding of the host factors conferring increased susceptibility to these diseases and their complications remains incomplete. Previous studies have uncovered defects in the innate Toll-like receptor 3 pathway and production of type I interferon (IFN-I) in children and adults that predispose them to herpes simplex encephalitis. More recently, there is accumulating evidence for an important role of IFN-independent cell-autonomous intrinsic mechanisms, including small nucleolar RNAs, RNA lariat metabolism, and autophagy, in restricting herpesvirus replication and conferring protection against CNS infection. The present review first describes clinical manifestations of HSV infection with a focus on neurological complications and then summarizes the host-pathogen interactions and innate immune pathways responsible for sensing herpesviruses and triggering antiviral responses and immunity. Next, we review the current landscape of inborn errors of immunity and the underlying genetic defects and disturbances of cellular immune pathways that confer increased susceptibility to HSV infection in CNS. Ultimately, we discuss some of the present outstanding unanswered questions relating to inborn errors of immunity and HSV CNS infection together with some perspectives and future directions for research in the pathogenesis of these severe diseases in humans.
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Si Y, He W, Guo S, Wang X, Tang M, Ying B, Wang M. Multiplex detection of meningitis and encephalitis pathogens: A study from laboratory to clinic. Front Neurol 2022; 13:1054071. [PMID: 36588904 PMCID: PMC9800896 DOI: 10.3389/fneur.2022.1054071] [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: 09/26/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Infectious meningitis and encephalitis (ME) are life-threatening conditions are caused by various pathogens. Conventional laboratory tests with low sensitivity and specificity cannot help with early diagnosis. Methods A prospective study using the novel multiplex PCR detection for 18 pathogens of ME (MME-18) was conducted to investigate the clinical utilization and the epidemiology characteristics of ME in southwestern China. Patients with suspected intracranial infection were recruited between May and October 2019 at West China Hospital of Sichuan University. The MME-18 was used to detect cerebrospinal fluid, and conventional experiments including cryptococcal capsular antigen detection, GeneXpert, real-time PCR, and clinical feedback were used to verify the result of MME-18. Results Among 581 tested patients, 139 eligible individuals were enrolled in the study. Among them, Mycobacterium tuberculosis was the most common pathogen in mono-infection. Viruses and Cryptococcus neoformans were also frequently detected. Of 139 infected patients, 12 cases were diagnosed by MME-18 only, 57 patients by conventional testing only, and 70 cases by both comparator tests and MME-18. There were 96.3% (79/82) diagnoses made by MME-18 had a favorable outcome, and two of twelve diagnoses, made solely by MME-18, had a likely unclear clinical significance. Discussion The MME-18 showed satisfactory consistency with expert clinical consensus for patients presenting with ME. Combined with conventional testing and clinical suspicion, MME-18 may help clinicians with the early identification of pathogens.
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Affiliation(s)
- Yanjun Si
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weijun He
- Department of Clinical Laboratory, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shuo Guo
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaohui Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Center for Infectious Diseases, Yaan People's Hospital, Yaan, Sichuan, China
| | - Meng Tang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Binwu Ying ✉
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China,*Correspondence: Minjin Wang ✉
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11
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Herpes simplex virus infection in Bulgarian patients with neurological diseases. JOURNAL OF CLINICAL VIROLOGY PLUS 2022. [DOI: 10.1016/j.jcvp.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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Petitgas P, Tattevin P, Mailles A, Fillâtre P, Stahl JP. Infectious encephalitis in elderly patients: a prospective multicentre observational study in France 2016-2019. Infection 2022:10.1007/s15010-022-01927-3. [PMID: 36152225 DOI: 10.1007/s15010-022-01927-3] [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: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Data on encephalitis in elderly patients are scarce. We aimed to describe the characteristics, aetiologies, management, and outcome of encephalitis in patients older than 65 years. METHODS We performed an ancillary study of ENCEIF, a prospective cohort that enrolled all cases of encephalitis managed in 46 clinical sites in France during years 2016-2019. Cases were categorized in three age groups: (1) 18-64; (2) 65-79; (3) ≥ 80 years. RESULTS Of the 494 adults with encephalitis enrolled, 258 (52%) were ≥ 65 years, including 74 (15%) ≥ 80 years. Patients ≥ 65 years were more likely to present with coma, impaired consciousness, confusion, aphasia, and rash, but less likely to present with fever, and headache (P < 0.05 for each). Median cerebrospinal fluid (CSF) white cells count was 61/mm3[13-220] in 65-79 years, 62 [17-180] in ≥ 80 years, vs. 114 [34-302] in < 65 years (P = 0.01). The proportion of cases due to Listeria monocytogenes and VZV increased after 65 years (P < 0.001), while the proportion of tick-borne encephalitis and Mycobacterium tuberculosis decreased with age (P < 0.05 for each). In-hospital mortality was 6/234 (3%) in < 65 years, 18/183 (10%) in 65-79 years, and 13/73 (18%) in ≥ 80 years (P < 0.001). Age ≥ 80 years, coma on admission, CSF protein ≥ 0.8 g/L and viral encephalitis were independently predictive of 6 month mortality. CONCLUSION Elderly patients represent > 50% of adults with encephalitis in France, with higher proportion of L. monocytogenes and VZV encephalitis, increased risk of death, and sequels. The empirical treatment currently recommended, aciclovir and amoxicillin, is appropriate for this age group.
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Affiliation(s)
- Paul Petitgas
- Service des Maladies Infectieuses et Réanimation Médicale, Université Rennes 1, Hôpital Pontchaillou, Centre Hospitalo-Universitaire (CHU), 35000, Rennes, France.,Service des Maladies Infectieuses et de Médecine Interne, CHU de Saint-Pierre, La Réunion, France
| | - Pierre Tattevin
- Service des Maladies Infectieuses et Réanimation Médicale, Université Rennes 1, Hôpital Pontchaillou, Centre Hospitalo-Universitaire (CHU), 35000, Rennes, France.
| | - Alexandra Mailles
- Santé Publique France, Direction des Maladies Infectieuses, Saint-Maurice, France
| | - Pierre Fillâtre
- Service de Réanimation Polyvalente, Saint-Brieuc, CH, France
| | - Jean-Paul Stahl
- Université Grenoble Alpes, CHU, Maladies Infectieuses, Grenoble, France
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14
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Primary HSV-2 Infection Complicated by Radiculomyelitis in a Young Immunocompetent Female Patient with Inherited Chromosomally Integrated HHV-6: A Case Report. Viruses 2022; 14:v14091979. [PMID: 36146785 PMCID: PMC9500849 DOI: 10.3390/v14091979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: HSV-1, HSV-2 and VZV are alpha Herpesviruses, neurotropic viruses that are associated with various neurologic complications upon primary infection or reactivation. Cases of myelitis and radiculomyelitis are rare and appropriate etiologic diagnoses can be tricky. Case presentation: Here we describe the case of a young immunocompetent woman who developed painful and extended vesicular genital lesions, with subsequent radiculomyelitis. HSV-1/-2 PCRs in the cerebrospinal fluid were misleadingly negative, whereas HHV-6 PCR was positive. Positive anti-HSV-2 IgM and IgG in serum was consistent with HSV-2 primary infection. On the other hand, the detection of HHV-6 DNA was explained by inherited chromosomally integrated HHV-6. The clinical course was favorable with high-dose IV acyclovir and corticosteroids. Conclusion: HSV-2-related radiculomyelitis is a rare clinical entity, which can be difficult to diagnose. In this case report, the causative virus was not detected in the patient’s CSF, whereas HHV-6 DNA, non-pathogenic in this situation, was paradoxically positive. The diagnosis was based on the clinical features typical for HSV-2 primary infection, confirmed by the serology results. The delay between the genital lesions and the appearance of the radiculomyelitis, along with the absence of HSV-2 detection in the CSF, suggests a possible immuno-mediated physiopathological process. As for the HHV-6 DNA detection in the patient’s CSF, it was explained by inherited chromosomally integrated HHV-6. This case illustrates how both negative and positive clinical virology results need careful interpretation according to the clinical findings.
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15
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van Zeggeren IE, ter Horst L, Heijst H, Teunissen CE, van de Beek D, Brouwer MC. Neurofilament light chain in central nervous system infections: a prospective study of diagnostic accuracy. Sci Rep 2022; 12:14140. [PMID: 35986031 PMCID: PMC9391449 DOI: 10.1038/s41598-022-17643-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Diagnosing central nervous system (CNS) infections quickly is often difficult. Neurofilament light chain (NfL) is a component of the axonal cytoskeleton and identified as marker of neuronal damage in several CNS diseases. We evaluated the diagnostic accuracy of NfL for diagnosing CNS infections. We included patients from a prospective cohort of consecutive patients in whom a lumbar puncture was performed for suspected CNS infection in an academic hospital in The Netherlands. The index test was NfL in cerebrospinal fluid (CSF) and reference standard the final clinical diagnosis. Diagnostic accuracy was determined using the area-under-the-curve (AUC) with 95% confidence intervals (CI). The association of CSF NfL with clinical characteristics, diagnosis and outcome was evaluated. Between 2012 and 2015, 273 episodes in adults of which sufficient CSF was available were included. CNS infection was diagnosed in 26%(n = 70), CNS inflammatory disease in 7%(n = 20), systemic infection in 32%(n = 87), and other neurological disorders in 33%(n = 90). Median CSF NfL level was 593 pg/ml (IQR 249–1569) and did not discriminate between diagnostic categories or CNS infection subcategories. AUC for diagnosing any CNS infection compared to patients without CNS infections was 0.50 (95% CI 0.42–0.59). Patients presenting with an altered mental status had higher NfL levels compared to other patients. We concluded that NfL cannot discriminate between causes in patients suspected of CNS infections. High concentrations of NfL are associated with severe neurological disease and the prognostic value of NfL in patients with CNS infections should be investigated in future research.
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16
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Huang BH, Inan-Eroglu E, Shaban RZ, Hamer M, Britton A, Stamatakis E. Alcohol intake and mortality risk of COVID-19, pneumonia, and other infectious diseases: An analysis of 437191 UK biobank participants. Prev Med Rep 2022; 26:101751. [PMID: 35251915 PMCID: PMC8883723 DOI: 10.1016/j.pmedr.2022.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate the association between alcohol consumption and COVID-19, infectious diseases, and pneumonia mortality. This is a prospective analysis of 437,191 UK Biobank participants (age 56.3 years, 54% female). The main exposure was self-reported alcohol consumption. In addition to never and previous drinkers, we applied quartiles-based and UK guidelines-based criteria to divide current drinkers by weekly consumption into four groups. Outcomes included COVID-19, infectious diseases, and pneumonia mortality, obtained from the national death registries until May 2020. After an 11-year follow-up, compared to never drinkers, previous drinkers had higher mortality risks of infectious diseases and pneumonia (adjusted HR: 1.29 [95% CI 1.06-1.57] and 1.35 [1.07-1.70], respectively), but not COVID-19. There was a curvilinear association of alcohol consumption with infectious diseases and pneumonia mortality. Drinking within-guidelines (<14 UK units/wk) and amounts up to double the recommendation (14 to < 28 UK units/wk) was associated with the lowest mortality risks of infectious diseases (0.70 [0.59-0.83] and 0.70 [0.59-0.83], respectively) and pneumonia (0.71 [0.58-0.87] and 0.72 [0.58-0.88], respectively). Alcohol consumption was associated with lower risks of COVID-19 mortality (e.g., drinking within-guidelines: 0.53 [0.33-0.86]). Drinkers reporting multiples of the recommended alcohol drinking amounts did not have higher mortality risks of COVID-19 and other infectious diseases than never drinkers. Despite the well-established unfavorable effects on general health, we found no deleterious associations between alcohol consumption and the risk of infectious diseases, including COVID-19. Future research with other study designs is needed to confirm the causality.
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Affiliation(s)
- Bo-Huei Huang
- Charles Perkins Centre, School of Health Sciences, the University of Sydney, New South Wales, Australia
| | - Elif Inan-Eroglu
- the Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine and Health, the University of Sydney, New South Wales, Australia
| | - Ramon Z. Shaban
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Western Sydney Local Health District, New South Wales Ministry of Health, New South Wales, Australia
| | - Mark Hamer
- Institute Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - Annie Britton
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, the University of Sydney, New South Wales, Australia
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17
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Zhang Y, Zhang H, Deng B, Lin K, Jin L, Liu X, Zhang Y, Chen X, Zhang Y, Lu S, Huang H, Wang Q, Feng T, Zhao W, Xue Q, Chen R, Zhang J, Qian X, Chen L, Ai J, Chen X, Zhang W. Optimal encephalitis/meningitis roadmap via precise diagnosis and treatment (IMPROVE): a study protocol for a randomized controlled trial. BMC Infect Dis 2022; 22:40. [PMID: 34998377 PMCID: PMC8742395 DOI: 10.1186/s12879-021-06943-6] [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: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Encephalitis/meningitis brings a heavy disease burden, and the origin of disease remains unknown in 30-40% of patients. It is greatly significant that combinations of nucleic acid amplification and autoimmune antibody testing improves the diagnosis and treatment of encephalitis/meningitis. Moreover, though several diagnostic methods are in clinical use, a recognized and unified diagnosis and treatment process for encephalitis management remains unclear. METHODS IMPROVE is a multicenter, open label, randomized controlled clinical trial that aims to evaluate the diagnostic performance, applications, and impact on patient outcomes of a new diagnostic algorithm that combines metagenomic next-generation sequencing (mNGS), multiplex polymerase chain reaction (PCR) and autoimmune antibody testing. The enrolled patients will be grouped into two parallel groups, multiplex PCR test plus autoimmune antibody group (Group I) or the mNGS plus autoimmune antibody group (Group II) with a patient ratio of 1:1. Both groups will be followed up for 12 months. The primary outcomes include the initial time of targeted treatment and the modified Rankin scale score on the 30th day of the trial. The secondary outcomes are the cerebrospinal fluid index remission rate on the 14th day, mortality rate on the 30th day, and an evaluation of diagnostic efficacy. The two groups are predicted to comprise of 484 people in total. DISCUSSION To optimize the roadmap of encephalitis/meningitis, precise diagnosis, and treatment are of great significance. The effect of rapid diagnosis undoubtedly depends on the progression of new diagnostic tests, such as the new multiplex PCR, mNGS, and examination of broad-spectrum autoimmune encephalitis antibodies. This randomized-controlled study could allow us to obtain an accurate atlas of the precise diagnostic ability of these tests and their effect on the treatment and prognosis of patients. Trial registration ClinicalTrial.gov, NCT04946682. Registered 29 June 2021, 'Retrospectively registered', https://clinicaltrials.gov/ct2/show/NCT04946682?term=NCT04946682&draw=2&rank=1.
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Affiliation(s)
- Yi Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haocheng Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Bo Deng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lei Jin
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoni Liu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanlin Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiaohua Chen
- Department of Infectious Diseases, Shanghai Sixth People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai, China
| | - Yanliang Zhang
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Shengjia Lu
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Heqing Huang
- Department of Infectious Diseases, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China
| | - Qiujing Wang
- Department of Infectious Diseases, Zhoushan Hospital of Zhejiang Province, Zhoushan, Zhejiang Province, China
| | - Tingting Feng
- Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Weifeng Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Renfang Chen
- Department of Infectious Diseases, Wuxi No.5 People 's Hospital, Wuxi, Jiangsu Province, China
| | - Jingbo Zhang
- Department of Neurology, Blue Cross Brain Hospital, Shanghai, China
| | - Xiaoyan Qian
- Department of Neurology, The first people's hospital of Kunshan, Suzhou, Jiangsu Province, China
| | - Lanlan Chen
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| | - Jingwen Ai
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Wenhong Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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18
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McGill F, Tokarz R, Thomson EC, Filipe A, Sameroff S, Jain K, Bhuva N, Ashraf S, Lipkin WI, Corless C, Pattabiraman C, Gibney B, Griffiths MJ, Geretti AM, Michael BD, Beeching NJ, McKee D, Hart IJ, Mutton K, Jung A, Miller A, Solomon T. Viral capture sequencing detects unexpected viruses in the cerebrospinal fluid of adults with meningitis. J Infect 2022; 84:499-510. [PMID: 34990710 DOI: 10.1016/j.jinf.2021.12.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Many patients with meningitis have no aetiology identified leading to unnecessary antimicrobials and prolonged hospitalisation. We used viral capture sequencing to identify possible pathogenic viruses in adults with community-acquired meningitis. METHODS Cerebrospinal fluid (CSF) from 73 patients was tested by VirCapSeq-VERT, a probe set designed to capture viral targets using high throughput sequencing. Patients were categorised as suspected viral meningitis - CSF pleocytosis, no pathogen identified (n = 38), proven viral meningitis - CSF pleocytosis with a pathogen identified (n = 15) or not meningitis - no CSF pleocytosis (n = 20). RESULTS VirCapSeq-VERT detected virus in the CSF of 16/38 (42%) of those with suspected viral meningitis, including twelve individual viruses. A potentially clinically relevant virus was detected in 9/16 (56%). Unexpectedly Toscana virus, rotavirus and Saffold virus were detected and assessed to be potential causative agents. CONCLUSION VirCapSeq-VERT increases the probability of detecting a virus. Using this agnostic approach we identified Toscana virus and, for the first time in adults, rotavirus and Saffold virus, as potential causative agents in adult meningitis. Further work is needed to determine the prevalence of atypical viral candidates as well as the clinical impact of using sequencing methods in real time. This knowledge can help to reduce antimicrobial use and hospitalisations leading to both patient and health system benefits.
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Affiliation(s)
- Fiona McGill
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
| | - Rafal Tokarz
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Emma C Thomson
- Institute of infection, immunity and inflammation, University of Glasgow, Glasgow, UK
| | - Ana Filipe
- Institute of infection, immunity and inflammation, University of Glasgow, Glasgow, UK
| | - Stephen Sameroff
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Komal Jain
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Nishit Bhuva
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Shirin Ashraf
- Institute of infection, immunity and inflammation, University of Glasgow, Glasgow, UK
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, NY, USA
| | - Caroline Corless
- Liverpool Specialist virology centre, Department of Infection and Immunity, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Chitra Pattabiraman
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; National Institute for Mental Health and Neurosciences, Bangalore, India
| | - Barry Gibney
- UK Health Security Agency (previously Public Health England), UK
| | - Michael J Griffiths
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Anna Maria Geretti
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Faculty of Medicine, University of Rome Tor Vergata
| | - Benedict D Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Nicholas J Beeching
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - David McKee
- Central Manchester Foundation Trust, Manchester, UK
| | - Ian J Hart
- Liverpool Specialist virology centre, Department of Infection and Immunity, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ken Mutton
- University of Manchester, Manchester, UK
| | - Agam Jung
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alastair Miller
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
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19
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Jakobsen A, Skov MT, Larsen L, Petersen PT, Brandt C, Wiese L, Hansen BR, Lüttichau HR, Tetens MM, Helweg-Larsen J, Storgaard M, Nielsen H, Bodilsen J. Herpes simplex virus 2 meningitis in adults: A prospective, nationwide, population-based cohort study. Clin Infect Dis 2022; 75:753-760. [PMID: 34979025 DOI: 10.1093/cid/ciab1071] [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: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on the clinical presentation are scarce and prognostic factors of Herpes simplex virus type 2 (HSV-2) meningitis remain unknown. METHODS Prospective, nationwide, population-based database identifying all adults treated for HSV-2 meningitis at departments of infectious diseases in Denmark from 2015-2020. Unfavorable outcome was defined as Glasgow Outcome Scale (GOS) score of 1-4 and extended GOS score of 1-6. Modified Poisson regression was used to compute relative risks with 95% confidence intervals (RR, 95% CI) for unfavorable outcome. RESULTS HSV-2 meningitis was diagnosed in 205 cases (76% female, median age 35 [IQR 27-49]) yielding an incidence of 0.7/100,000/year. Common symptoms were headache 195/204 (95%), photo/phonophobia 143/188 (76%), and neck stiffness 106/196 (54%). Median time to lumbar puncture was 2.0 hours (IQR 1-4.8) and cerebrospinal fluid (CSF) leukocyte count was 360x10 6/L (IQR 166-670) with a mononuclear predominance of 97% (IQR 91-99). Lumbar puncture was preceded by brain imaging in 61/205 (30%). Acyclovir/valaciclovir was administered in 197/205 (96%) cases for a median of 10 days (IQR 7-14).Unfavorable outcome was observed in 64/205 (31%) at discharge and 19/181 (11%) after six months and was not associated with female sex (RR 1.08, 95% CI 0.65-1.79), age ≥35 years (1.28, 0.83-1.97), immuno-compromise (1.07, 0.57-2.03), or CSF leukocyte count >1,000x10 6/L (0.78, 0.33-1.84). CONCLUSIONS HSV-2 meningitis often presented as meningeal symptoms in younger females. Unfavorable outcome at discharge was common and was not associated with sex, age, immune-compromise, or CSF leukocyte count. Sequelae persisted beyond six months in one tenth of patients.
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Affiliation(s)
- Anna Jakobsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Marie Thaarup Skov
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Lykke Larsen
- Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Christian Brandt
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.,Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | | | - Hans Rudolf Lüttichau
- Department of Medicine and Infectious Diseases, Herlev Gentofte Hospital, Herlev Copenhagen, Denmark
| | - Malte Mose Tetens
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Damiano RF, Guedes BF, de Rocca CC, de Pádua Serafim A, Castro LHM, Munhoz CD, Nitrini R, Filho GB, Miguel EC, Lucchetti G, Forlenza O. Cognitive decline following acute viral infections: literature review and projections for post-COVID-19. Eur Arch Psychiatry Clin Neurosci 2022; 272:139-154. [PMID: 34173049 PMCID: PMC8231753 DOI: 10.1007/s00406-021-01286-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Recently, much attention has been drawn to the importance of the impact of infectious disease on human cognition. Several theories have been proposed, to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia, especially Alzheimer's disease. This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition, laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 (COVID-19). To reach this goal, we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID-19 and its impact on human cognition. Recent findings suggest probable short- and long-term COVID-19 impacts in cognition, even in asymptomatic individuals, which could be accounted for by direct and indirect pathways to brain dysfunction. Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID-19 pandemic as well as with other acute viral infections, to alleviate the cognitive sequelae of these infections around the world.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Bruno F. Guedes
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Cristiana Castanho de Rocca
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Antonio de Pádua Serafim
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | | | - Carolina Demarchi Munhoz
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Geraldo Busatto Filho
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Eurípedes Constantino Miguel
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Giancarlo Lucchetti
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Orestes Forlenza
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
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21
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Bodilsen J, Brouwer MC, van de Beek D, Tattevin P, Tong S, Naucler P, Nielsen H. Partial oral antibiotic treatment for bacterial brain abscess: an open-label randomized non-inferiority trial (ORAL). Trials 2021; 22:796. [PMID: 34772441 PMCID: PMC8588941 DOI: 10.1186/s13063-021-05783-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background The advised standard treatment for bacterial brain abscess following surgery is 6 to 8 weeks of intravenous (IV) antibiotic treatment, but an early switch to oral antibiotic treatment has been suggested to be equally effective. Methods This investigator-initiated, international, multi-center, parallel group, open-label, randomized (1:1 allocation) controlled trial will examine if oral treatment after 2 weeks of IV antibiotic therapy is non-inferior to standard 6–8 weeks of IV antibiotics for bacterial brain abscess in adults (≥ 18 years of age). The study will be conducted at hospitals across Denmark, the Netherlands, France, Australia, and Sweden. Exclusion criteria are severe immunocompromise or impaired gastro-intestinal absorption, pregnancy, device-related brain abscesses, and brain abscess caused by nocardia, tuberculosis, or Pseudomonas spp. The primary objective is a composite endpoint at 6 months after randomization consisting of all-cause mortality, intraventricular rupture of brain abscess, unplanned re-aspiration or excision of brain abscess, relapse, or recurrence. The primary endpoint will be adjudicated by an independent blinded endpoint committee. Secondary outcomes include extended Glasgow Outcome Scale scores and all-cause mortality at end of treatment as well as 3, 6, and 12 months since randomization, completion of assigned treatment, IV catheter associated complications, durations of admission and antibiotic treatment, severe adverse events, quality of life scores, and cognitive evaluations. The planned sample size is 450 patients for a one-sided alpha of 0.025 and a power of 90% to exclude a difference in favor of standard treatment of more than 10%. Date of initiation of first study center was November 3, 2020, with active recruitment for 3 years and follow-up for 1 year of all patients. Discussion The results of this study may guide future recommendations for treatment of bacterial brain abscess. If early transition to oral antibiotics proves non-inferior to standard IV treatment, this will provide considerable health and costs benefits. Trial registration ClinicalTrials.gov NCT04140903, first registered 28.10.2019. EudraCT number: 2019-002845-39, first registered 03.07.2019
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark. .,European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.
| | - Matthijs C Brouwer
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Tattevin
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.,Réseau National de Recherche Clinique en Infectiologie (RENARCI), Paris, France
| | - Steven Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Australia.,Department of Infectious Diseases University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Nielsen
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Infectious Diseases and Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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22
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Knudtzen FC, Eikeland R, Bremell D, Quist-Paulsen E, Johansen IS, Solheim AM, Skarphédinsson S. Lyme neuroborreliosis with encephalitis; a systematic literature review and a Scandinavian cohort study. Clin Microbiol Infect 2021; 28:649-656. [PMID: 34768019 DOI: 10.1016/j.cmi.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described. OBJECTIVES To describe the available literature on LNB encephalitis, and to characterize this patient-group through a Scandinavian retrospective cohort study. DATA-SOURCES Medline, Embase, Scopus, Cochrane library. STUDY ELIGIBILITY CRITERIA No discrimination on study-type, time of publication or language. PARTICIPANTS Review: all articles with definite LNB and confirmed/possible encephalitis. Cohort: LNB cohorts from Denmark, Sweden and Norway 1990-2019 screened for patients with encephalitis. METHODS Review: adhering to PRISMA guidelines, two authors extracted and assessed quality of studies. Cohort: data registered on demography, symptoms, CSF-findings, differentialdiagnostic examinations, treatment, residual symptoms, one-year mortality. RESULTS Review: 2330 articles screened on title/abstract, 281 full-texts, yielding 42 articles (case reports/series or cohort studies) including 45 patients from 18 countries spanning 35 years. Altered mental status ranged from personality changes and confusion to unconsciousness. Common focal symptoms were hemiparesis, ataxia and dysarthria, seven patients had seizures. Median time from symptom onset to hospital was 2 weeks (IQR 2-90 days). Of 38 patients with available follow-up after median 12 months (IQR 5-13), 32 had fully or partially recovered, 2 had died. Cohort: 35 patients (median age 67 years,IQR 48-76) were included. The encephalitis prevalence was 3.3%(95%CI 2.2-4.4%) among 1019 screened LNB-patients. Frequent encephalitis symptoms were confusion, personality-changes, aphasia, ataxia. EEGs and neuroimaging showed encephalitis in 93.8% and 20.6%, respectively. Median delay from symptom onset to hospital was 14 days(IQR 7-34), with further 7 days(IQR 3-34) delay until targeted therapy. At follow-up (median 298 days post-treatment(IQR 113-389)), 65.6% had residual symptoms. None had died. CONCLUSIONS This study shows that encephalitis is an uncommon, but likely overlooked clinical manifestation of LNB. As the high frequency of residual symptoms may be related to prolonged treatment delay, prompt LNB testing of patients with encephalitis in B.burgdorferi-endemic areas should be considered.
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Affiliation(s)
- Fredrikke Christie Knudtzen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Randi Eikeland
- The Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital, Arendal, Norway; Faculty of Health & Sport Sciences, University of Agder, Norway
| | - Daniel Bremell
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Else Quist-Paulsen
- Department of Microbiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anne-Marit Solheim
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Sigurdur Skarphédinsson
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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23
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Bodilsen J, Larsen L, Brandt CT, Wiese L, Hansen BR, Andersen CØ, Lüttichau HR, Helweg-Larsen J, Storgaard M, Nielsen H. Existing Data Sources for Clinical Epidemiology: The Danish Study Group of Infections of the Brain Database (DASGIB). Clin Epidemiol 2021; 13:921-933. [PMID: 34675681 PMCID: PMC8500496 DOI: 10.2147/clep.s326461] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
Central nervous system (CNS) infections are rare diseases that are associated with considerable morbidity and mortality. Increased knowledge based on contemporary data is a prerequisite for improved management and prevention of these serious conditions. Yet, population-based databases of patients hospitalized with CNS infections remain scarce. The Danish Study Group of Infections of the Brain (DASGIB) has prospectively registered information on all adults ≥18 years of age admitted with CNS infections at departments of infectious diseases in Denmark since 2015. The main variables collected are baseline demographics, blood and cerebrospinal fluid tests, imaging results, and outcome using the Glasgow Outcome Scale score. To investigate important aspects for each type of CNS infections, additional variables are included specifically for bacterial meningitis, viral meningitis, encephalitis, brain abscess, neurosyphilis, and Lyme neuroborreliosis. From 2015 to 2020, a total of 3579 cases of CNS infections have been recorded in the DASGIB database. Using the unique civil registration number assigned to all Danish residents, the database can be unambiguously linked with nationwide healthcare registries at the individual level. This enables researchers to conduct detailed population-based and longitudinal observational studies of risk and prognosis of CNS infections and to compare them with matched population cohorts. The database is well-suited for epidemiological research and the DASGIB network forms a solid infrastructure for future national and international collaborations.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, 5000, Denmark
| | - Christian Thomas Brandt
- Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, 3400, Denmark.,Department of Infectious Diseases, Sjælland University Hospital, Roskilde, 4000, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, 4000, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, 2650, Denmark
| | | | - Hans Rudolf Lüttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, 2730, Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, 8200, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark
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24
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Carr K, Ogbuagu O. Late neurosyphilis and VZV meningoencephalitis coinfection. BMJ Case Rep 2021; 14:14/6/e240412. [PMID: 34162599 DOI: 10.1136/bcr-2020-240412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The incidence of syphilis has increasing recently, largely attributable to improved screening that may result in the diagnosis of chronic untreated infections. These patients can develop severe or subtle neurologic symptoms that can be missed and, therefore, detected accidentally while a patient is evaluated for other mimicking neurological infections. A 58-year-old man with diabetes presented with 2 days of aphasia, headache, chills and confusion. He had an MRI brain with evidence of a prior cerebrovascular accident. Subsequently, he developed a fever and thoracic dermatomal rash consistent with herpes zoster. A lumbar puncture was performed, and cerebrospinal fluid analysis revealed a lymphocytic pleocytosis, a reactive Venereal Disease Research Laboratory test and positive varicella-zoster virus (VZV) PCR. He was suspected to have both late neurosyphilis and acute meningoencephalitis from VZV. This paper will discuss how to approach the diagnosis of late neurosyphilis and possible associations with herpesvirus central nervous system infections.
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Affiliation(s)
- Kristin Carr
- Infectious Diseases, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Onyema Ogbuagu
- Infectious Diseases, Yale-New Haven Hospital, New Haven, Connecticut, USA
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25
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Bodilsen J, Mens H, Midgley S, Brandt CT, Petersen PT, Larsen L, Hansen BR, Lüttichau HR, Helweg-Larsen J, Wiese L, Østergaard C, Storgaard M, Nielsen H. Enterovirus Meningitis in Adults: A Prospective Nationwide Population-Based Cohort Study. Neurology 2021; 97:e454-e463. [PMID: 34088872 DOI: 10.1212/wnl.0000000000012294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that enterovirus meningitis (EM) is a frequent and self-limiting condition, the epidemiology of EM in adults was examined. METHODS Using a prospective, nationwide, population-based database, all adults with EM confirmed by PCR of the CSF from 2015 to 2019 were included. Unfavorable outcome was defined as Glasgow Outcome Scale scores of 1-4 at discharge. Modified Poisson regression was used to compute adjusted relative risks (RRs). RESULTS A total of 419 cases of EM in 418 adults (46% female, median age 31 years [interquartile range (IQR) 27-35]) yielded an incidence of 1.80/100,000/year. Admission diagnoses included CNS infection 247/397 (62%), other neurologic conditions 89/397 (22%), and cerebrovascular diseases 33/397 (8%). Genotype was available for 271 cases, of which echovirus 30 accounted for 155 (57%). Patients presented with headache 412/415 (99%), history of fever 303/372 (81%), photophobia 292/379 (77%), and neck stiffness 159/407 (39%). Fever (≥38.0°C) was observed in 192/399 (48%) at admission. The median CSF leukocyte count was 130 106/L (range 0-2,100) with polymorphonuclear predominance (>50%) in 110/396 (28%). Cranial imaging preceded lumbar puncture in 127/417 (30%) and was associated with non-CNS infection admission diagnoses and delayed lumbar puncture (median 4.8 hours [IQR 3.4-7.9] vs 1.5 [IQR 0.8-2.8], p < 0.001). Unfavorable outcome occurred in 99/419 (24%) at discharge; more often in female patients (RR 2.30 [1.58-3.33]) and less frequent in echovirus 30 (RR 0.67 [0.46-1.00]) in adjusted analyses. Outcome remained unfavorable in 22/379 (6%) after 6 months. CONCLUSIONS EM is common among young, healthy adults. Although the long-term prognosis remains reassuring, a substantial proportion have moderate disability at discharge, especially female patients.
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Affiliation(s)
- Jacob Bodilsen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark.
| | - Helene Mens
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Sofie Midgley
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Christian Thomas Brandt
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Pelle Trier Petersen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Lykke Larsen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Birgitte Rønde Hansen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Hans Rudolf Lüttichau
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Jannik Helweg-Larsen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Lothar Wiese
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Christian Østergaard
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Merete Storgaard
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
| | - Henrik Nielsen
- From the Department of Infectious Diseases (J.B.), Aalborg University Hospital; Department of Pulmonary and Infectious Diseases (H.M., C.T.B., P.T.P.), Nordsjællands Hospital, Hillerød; Department of Infectious Diseases (H.M., J.H.-L.), Rigshospitalet; Virology Surveillance and Research Section (S.M.), Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen; Department of Infectious Diseases (L.L.), Odense University Hospital; Department of Infectious Diseases (B.R.H.), Hvidovre University Hospital; Department of Clinical Microbiology (C.Ø.), Copenhagen University Hospital, Amager and Hvidovre; Department of Infectious Diseases (H.R.L.), Copenhagen University Hospital, Herlev and Gentofte,; Department of Medicine (L.W.), Zealand University Hospital, Roskilde; Department of Infectious Diseases (M.S.), Aarhus University Hospital; and Departments of Infectious Diseases (H.N.) and Clinical Medicine (H.N.), Aalborg University, Denmark
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Herlin LK, Hansen KS, Bodilsen J, Larsen L, Brandt C, Andersen CØ, Hansen BR, Lüttichau HR, Helweg-Larsen J, Wiese L, Storgaard M, Nielsen H, Mogensen TH. Varicella Zoster Virus Encephalitis in Denmark From 2015 to 2019-A Nationwide Prospective Cohort Study. Clin Infect Dis 2021; 72:1192-1199. [PMID: 32103249 DOI: 10.1093/cid/ciaa185] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited. METHODS Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome. RESULTS We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2-6.6). Median age was 75 years (IQR, 67-83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2-46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5-31.0) and 18.5 hours (4.9-42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1-4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01-1.03), vasculitis (aRR, 1.38; 95% CI, 1.02-1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01-1.73) identified as independent risk factors. CONCLUSIONS VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.
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Affiliation(s)
- Laura Krogh Herlin
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Christian Brandt
- Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | | | | | | | | | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Trine H Mogensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Diagnostic accuracy of VIDISCA-NGS in patients with suspected central nervous system infections. Clin Microbiol Infect 2021; 27:631.e7-631.e12. [DOI: 10.1016/j.cmi.2020.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023]
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Abstract
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies.
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29
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Shikova E, Kumanova A, Tournev I, Zhelyazkova S, Vassileva E, Ivanov I, Pishmisheva M. Varicella zoster virus infection in neurological patients in Bulgaria. J Neurovirol 2021; 27:272-278. [PMID: 33661458 DOI: 10.1007/s13365-021-00952-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
The clinical manifestations of neurological complications associated with varicella zoster virus (VZV) are non-specific and indistinguishable from those of other viral infections. Therefore, the definite diagnosis requires evidence of VZV infection in cerebrospinal fluid (CSF). The aim of this study was to determine the frequency of VZV DNA detection in CSF of patients with neurological diseases in order to obtain information concerning involvement of VZV infection in neuropathology in the country. This study is a retrospective survey of test results obtained from January 2015 to October 2019. During this period, 411 CSF specimens were tested for the presence of VZV DNA by nested PCR. Fisher's exact test was used to test for statistically significant difference in the frequency of VZV DNA positivity of CSF specimens from different groups. Of all 411 tested CSF samples, 11.2% were positive for VZV DNA. The highest VZV prevalence was detected in CFS from patients with meningitis-18.2%, followed by patients with cranial neuritis (15.4%), encephalitis (12.2%), Guillain-Barré syndrome (11.1%), myelitis (10%), and with other neurological syndromes (8.2%). The difference of VZV prevalence in CSF of patients according to the gender and age was not statistically significant. Our results indicated that VZV is a frequent causative agent of neurological diseases, suggesting an important role of VZV infection for neuropathology in the country. Therefore, efforts for wider application of VZV identification in CSF to facilitate faster onset of antiviral treatment and further strategies concerning varicella zoster virus vaccines in the country are needed.
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Affiliation(s)
- Evelina Shikova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria. .,Central Microbiology Laboratory, University Hospital "Alexandrovska", Sofia, Bulgaria.
| | - Antoniya Kumanova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Ivailo Tournev
- Clinic of Neurology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Sashka Zhelyazkova
- Clinic of Neurology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - Evgenia Vassileva
- Clinic of Neurology, University Hospital "Tsaritsa Yoanna - ISUL", Sofia, Bulgaria
| | - Ivan Ivanov
- Department of Pediatrics, Faculty of Medicine, St. George University Hospital, Medical University - Plovdiv, Plovdiv, Bulgaria
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30
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Abstract
BACKGROUND Adenovirus (Adv) is a frequent etiology of acute respiratory tract infections. Although rare, neurologic manifestations are known to occur during Adv infection. METHODS We retrospectively analyzed clinical, laboratory, outcome and the relationship between clinical characteristics and viral detection results in the cerebrospinal fluid (CSF) in children with Adv-associated central nervous system (CNS) dysfunction. RESULTS TWENTYONE (1.5%) cases had Adv-associated CNS manifestations. The median age was 1.4 years and 20 (95%) were less than 5 years of age. Six (28%) were male. The most frequently cited CNS symptoms were altered consciousness (100%) and seizure (14.3%). Fourteen cases (73.7%) had abnormal electroencephalogram examination and 6 cases (37.5%) had abnormal imaging. None of the patients had received cidofovir administration. Twenty children recovered without sequelae and 1 patient died of respiratory failure. Patients with positive Adv polymerase chain reaction (n = 11) presented lower onset age compared with that of patients with negative Adv polymerase chain reaction (n = 10) in the CSF. Clinical manifestation, laboratory findings, imaging studies and electroencephalogram showed no significant difference between the 2 groups. CONCLUSION Adv is a rare cause of CNS disease in children, mainly causing altered consciousness. Adv was detected in more cases in the respiratory tract than the CSF, but the majority of patients had the virus detected in both. The lack of Adv in the CSF does not exclude CNS involvement. Furthermore, the viral detection results in the CSF do not seem useful as an indicator of the severity of CNS disease.
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31
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Grønhøj MH, Sejbaek T, Hansen RW, Larsen L, Dahl M, Schierbeck J, Poulsen FR. Serum levels of neurofilament light chain, neuron-specific enolase and S100 calcium-binding protein B during acute bacterial meningitis: a prospective cohort study. Infect Dis (Lond) 2021; 53:409-419. [PMID: 33583314 DOI: 10.1080/23744235.2021.1883730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Acute bacterial meningitis (ABM) is a severe disease with an overall poor outcome. Neurofilament (NFL) has shown to be a promising biomarker of neuroaxonal injury in various neurological disorders but has not been investigated in ABM. The aims of this study were (i) to obtain a temporal profile of NFL, neuron-specific enolase (NSE) and S100B in serum during ABM, and (ii) to evaluate their use as biomarkers of severity (Glasgow coma score) and prognosis (Glasgow Outcome Score, GOS and death) in severe ABM. METHODS Fifteen adults with severe community-acquired ABM who were admitted to the intensive care unit (ICU) and fulfilled the inclusion criteria were included. Lumbar puncture and blood tests were performed on admission, and blood tests were performed three times daily during the ICU stay. GOS was obtained day 30. RESULTS Serum NFL was significantly elevated in ABM patients compared to healthy controls, both at admission and throughout the observation period (p < .01). NFL increased significantly from day 1 up to day 3-6 (p < .0001), peaking day 6. NSE increased significantly from admission up to day 3 (p < .01). At day 5-6, the serum values were not significantly different from values at admission. The highest median serum value of S100B was observed at admission (0.10 µg/L, IQR 0.06-0.14), significantly decreasing day 4-6 (p < .05). None of the investigated biomarkers revealed significant correlation with severity and prognosis. CONCLUSION This study represents a first clinical observation of the temporal profile of NFL in serum, in severe ABM. No correlation with severity or prognosis.
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Affiliation(s)
| | - Tobias Sejbaek
- Department of Neurology, Esbjerg Central Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lykke Larsen
- Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, Koege, Denmark
| | - Jens Schierbeck
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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32
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Ørbæk M, Bodilsen J, Gynthersen RMM, Shekhrajka N, Nordberg CL, Larsen L, Storgaard M, Brandt C, Wiese L, Hansen BR, Luttichau HR, Andersen AB, Mens H, Nielsen H, Lebech AM. CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study. J Neurol Sci 2020; 419:117176. [PMID: 33130434 DOI: 10.1016/j.jns.2020.117176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to describe the use and findings of cranial computerized tomography (CT-head), spine and brain magnetic resonance imaging (MRI-spine/MRI-brain) in Lyme neuroborreliose (LNB). METHODS Patients with LNB were identified using a nationwide, population-based prospective cohort of all adults treated for neuroinfections at departments of infectious diseases in Denmark from 2015 to 2019. Multivariate logistic regression analyses assessed associations between clinical characteristics and MRI-findings consistent with LNB. RESULTS We included 368 patients (272 definite LNB and 96 probable LNB), 280 scans were performed in 198 patients. Neuroimaging was associated with older age (59 vs. 57, p = 0.03), suspicion of other diseases (77% vs. 37%, p < 0.0001), no history of tick bites (58% vs. 43%, p = 0.01), physical/cognitive deficits prior to admission (15% vs 5%, p = 0.006), peripheral palsy (10% vs. 2%, p = 0.0008), encephalitis (8% vs. 1%, p = 0.0007) and cognitive impairment (8% vs. 2%, p = 0.03) compared with those without neuroimaging. Normal or incidental findings were common (93/98 CT-head and 154/182 MRI). 1/98 CT-head, 19/131 MRI-brain and 6/51 MRI-spine had findings consistent with LNB. Symptoms ≥45 days was associated with MRI-findings consistent with LNB (adjusted odds ratio (aOR) 4.2, 95%confidence interval 1.2-14.4, p = 0.02). CONCLUSION In this Danish cohort including 368 LNB-patients, use of neuroimaging was common and often performed in older comorbid patients without previous tick-bite intended to investigate alternative diagnoses. The results were in general without pathology and neuroimaging cannot exclude LNB or replace lumbar puncture. MRI is of value when investigating alternative neurological diseases and may support suspicion of LNB in cases with meningeal/leptomeningeal/neural enhancement.
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Affiliation(s)
- Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | | | - Nitesh Shekhrajka
- Department of Neuroradiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Brandt
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark; Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
| | - Hans R Luttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helene Mens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
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Treatment of community-acquired bacterial brain abscess: a survey among infectious diseases specialists in France, Sweden, Australia, and Denmark. Eur J Clin Microbiol Infect Dis 2020; 40:255-260. [PMID: 32880024 DOI: 10.1007/s10096-020-04032-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023]
Abstract
To examine antimicrobial management of brain abscess and prioritize future trials. Self-administered, Internet-based survey of practices for treatment of community-acquired bacterial brain abscess among infectious diseases (ID) specialists in France, Sweden, Australia, and Denmark during November 2019. Respondents were also asked to rank future randomized controlled trials (RCTs) from 1 (high priority) to 6 (low priority). 310 ID specialists (45% female) from France (35%), Sweden (29%), Australia (25%), and Denmark (11%) participated in the survey, primarily from university hospitals (69%) with an on-site neurosurgical department (61%). Preferred empiric intravenous (IV) antimicrobials were cefotaxime (154/273, 56%) or ceftriaxone (68/273, 25%) combined with metronidazole for a median of 4 weeks (IQR 4-6), 4 weeks (IQR 2-4), and 6 weeks (IQR 4-6) for aspirated, excised, and conservatively treated patients, respectively. Early transition to oral antimicrobials (i.e., < 4 weeks of IV antimicrobials) was used by 134/269 (50%), whereas consolidation therapy with oral antimicrobials after a standard IV regimen (i.e., 4-8 weeks) was used by 123/264 (47%). Median prioritization scores for future RCTs were as follows: 1 (IQR 1-2) for an early transition to oral antimicrobials and duration of therapy, 3 (IQR 2-4) for comparisons of antimicrobial regimens, use of adjunctive dexamethasone, and neurosurgical aspiration versus excision, and 4 (IQR 3-5) for intracavitary antimicrobial instillation and drainage, and for prophylactic anti-epileptic therapy. Willingness to include patients into RCTs reflected prioritization scores. Duration of intravenous antimicrobial treatment and use of oral antimicrobials varies substantially among ID specialists. RCTs are needed to define optimal treatment of brain abscess.
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Vestergaard HH, Larsen L, Brandt C, Hansen BR, Andersen CØ, Lüttichau HR, Helweg-Larsen J, Wiese L, Storgaard M, Nielsen H, Bodilsen J. Normocellular Community-Acquired Bacterial Meningitis in Adults: A Nationwide Population-Based Case Series. Ann Emerg Med 2020; 77:11-18. [PMID: 32747082 DOI: 10.1016/j.annemergmed.2020.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE This study sought to describe the clinical presentation of normocellular community-acquired bacterial meningitis in adults. METHODS Using the prospective, nationwide, population-based database of the Danish Study Group of Infections of the Brain, the study identified all adults with normocellular community-acquired bacterial meningitis who were treated at departments of infectious diseases in Denmark from 2015 through 2018. Normocellular community-acquired bacterial meningitis was defined as a cerebrospinal fluid leukocyte count of up to 10×106/L combined with detection of bacteria in the cerebrospinal fluid. Outcome was categorized according to the Glasgow Outcome Scale at discharge. RESULTS Normocellular cerebrospinal fluid was observed in 12 of 696 (2%) patients with community-acquired bacterial meningitis. The median age was 70 years (range 17 to 92 years), and 8 of 12 (67%) patients were male. All patients had symptoms suggestive of community-acquired bacterial meningitis and pathogens identified by culture (Streptococcus pneumoniae, n=10; Staphylococcus aureus, n=1) or polymerase chain reaction (Neisseria meningitidis; n=1) of the cerebrospinal fluid. Bacteremia was found in 9 of 12 (75%) patients, and 1 of 12 (8%) presented with septic shock. None of the patients had serious underlying immunocompromising conditions. The median times from admission to lumbar puncture and meningitis treatment were 2.5 hours (interquartile range 1.1 to 3.9 hours) and 2.6 hours (interquartile range 0.9 to 22.8 hours). In 3 of 11 (27%) patients, empiric treatment for community-acquired bacterial meningitis was interrupted by a normal cerebrospinal fluid cell count. The overall case-fatality rate was 3 of 12 (25%); meningitis treatment was interrupted in 1 of these patients, and 8 of 12 (67%) had a Glasgow Outcome Scale score of 1 to 4 at discharge. CONCLUSION Normocellular community-acquired bacterial meningitis is not very common, but it is important to consider and may be associated with a pneumococcal cause.
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Affiliation(s)
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Christian Brandt
- Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Birgitte R Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Christian Ø Andersen
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Hans R Lüttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, Denmark
| | | | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
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Pedersen EMJ, Köhler-Forsberg O, Nordentoft M, Christensen RHB, Mortensen PB, Petersen L, Benros ME. Infections of the central nervous system as a risk factor for mental disorders and cognitive impairment: A nationwide register-based study. Brain Behav Immun 2020; 88:668-674. [PMID: 32353515 DOI: 10.1016/j.bbi.2020.04.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND CNS infections have been suggested as risk factors for cognitive decline and mental disorders; however, large-scale studies have been lacking regarding types and agents of CNS infections. METHODS We utilized the unique personal registration number to create a cohort of 1,709,867 individuals born 1977-2010. CNS infection was exposure and data were analysed with 1) cox regression analyses estimating hazard ratios (HR) for developing mental disorders and 2) binomial regression estimating relative risk (RR) for completion of 9th grade including average grade score in a sub-cohort born 1988-1998. RESULTS CNS infection increased the risk for developing mental disorders with a HR of 1.34 (95% CI 1.27-1.42). The highest risk observed was within the first 6 months after the CNS infection with a HR of 26.98 (95% CI 21.19-34.35). Viral CNS infections (HR 1.47, 95% CI 1.35-1.61) conferred a higher risk (p < 0.001) than bacterial (HR 1.24, 95% CI 1.15-1.35). Encephalitis (HR 1.64, 95% CI 1.41-1.90) conferred a higher risk (p < 0.001) than meningitis (HR 1.26, 95% CI 1.18-1.35). The risk was highest for organic mental disorders (HR 6.50, 95% CI 5.11-8.28) and disorders of intellectual development (HR 3.56, 95% CI 2.94-4.31), with a HR of 19.19 (95% CI 7.46-49.35) for profound disorder of intellectual development (IQ < 20). Furthermore, CNS infection decreased the RR of completing 9th grade of mandatory schooling (RR 0.89, 95% CI 0.88-0.91) and lowered average grade score for completers (p < 0.001). CONCLUSIONS CNS infections increased the risk for mental disorders and decreased the likelihood of completing 9th grade, indicating long-term consequences of CNS infections.
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Affiliation(s)
| | - Ole Köhler-Forsberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | | | - Preben B Mortensen
- National Centre for Register-based Research, Aarhus University, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus University, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Michael E Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark; National Centre for Register-based Research, Aarhus University, Denmark; Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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36
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Hansen ABE, Vestergaard HT, Dessau RB, Bodilsen J, Andersen NS, Omland LH, Christiansen CB, Ellermann-Eriksen S, Nielsen L, Benfield T, Sørensen HT, Andersen CØ, Lebech AM, Obel N. Long-Term Survival, Morbidity, Social Functioning and Risk of Disability in Patients with a Herpes Simplex Virus Type 1 or Type 2 Central Nervous System Infection, Denmark, 2000-2016. Clin Epidemiol 2020; 12:745-755. [PMID: 32765109 PMCID: PMC7371560 DOI: 10.2147/clep.s256838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background The long-term prognosis following herpes simplex virus (HSV) central nervous system (CNS) infection is still debated. Patients and Methods We examined outcomes in all Danish residents who, during 2000–2016, tested PCR positive for HSV-1 (n=208) or HSV-2 (n=283) in the cerebrospinal fluid, compared to comparison cohorts from the general population (n=2080 and n=2830). Results One-year mortality was increased among HSV-1 patients (difference 19.3%; 95% CI: 13.6% to 25.0%) and HSV-2 patients (difference 5.3%; 95% CI: 2.5% to 8.1%), but thereafter mortality was not increased. After exclusion of persons diagnosed with cancer prior to study inclusion, one-year mortality difference for HSV-2 patients was 1.7% (−0.1% to 3.5%). After five years, HSV-1 patients had lower employment (difference −19.8%; 95% CI: −34.7% to −4.8%) and higher disability pension rates (difference 22.2%; 95% CI: 8.4% to 36.0%) than the comparison cohort, but similar number of inpatient days, outpatient visits, and sick leave. HSV-2 patients had employment and disability pension rates comparable to the comparison cohort, but more inpatient days (difference 1.5/year; 95% CI: −0.2 to 3.2), outpatient visits (difference 1.3/year; 95% CI: 0.3 to 3.2), and sick leave days (difference 9.1/year; 95% CI: 7.9 to 10.4). Conclusion HSV-1 and HSV-2 CNS infections differ substantially with respect to prognosis. HSV-1 CNS infection is followed by increased short-term mortality and long-term risk of disability. HSV-2 CNS infection has no substantial impact on mortality or working capability but is associated with increased morbidity.
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Affiliation(s)
- Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne T Vestergaard
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Departments of Infectious Diseases and Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Amager Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pormohammad A, Goudarzi H, Eslami G, Falah F, Taheri F, Ghadiri N, Faghihloo E. Epidemiology of herpes simplex and varicella zoster virus in cerebrospinal fluid of patients suffering from meningitis in Iran. New Microbes New Infect 2020; 36:100688. [PMID: 32528686 PMCID: PMC7276451 DOI: 10.1016/j.nmni.2020.100688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
Abstract
From the early 18th century that “meningitis” outbreak was firstly recorded in Geneva, it is one of the alarming health problems worldwide. Different infectious risk factors may contribute to the progression of meningitis. Herpes simplex virus (HSV) and Varicella-zoster virus (VZV) are just some noticeable risk factors among many involved in the progression of this disease. In this study, 415 meningitis suspected patients were recruited with some symptoms, such as fever, headache, nausea or vomiting, seizure, rash, dizziness from four different hospitals of Iran and molecular examinations of samples were performed by using specific primers of HSV½ and VZV via real-time PCR. Out of 415 included patient 41 (9.8 %) were VZV and six (1.4 %) cases were HSV ½ positive. Fever was the most frequent symptom by 315 (76 %) of patients with median temperature of 38 °C in all included patients. The median WBS counts of CSF in VZV positive, HSV½ positive, and all included cases were 1567 × 106 /L, 1257 × 106 /L, and 766 × 106 /L (range 0-21200), respectively. In conclusion, as the rate of VZV infection was high among children patients and it was associated with the absence of vaccination program for chickenpox in Iran, we suggested that VZV is one of the plausible hallmarks in meningitis.
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Affiliation(s)
- A Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - H Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - G Eslami
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Falah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Taheri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Ghadiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Faghihloo
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dittrich T, Marsch S, Egli A, Rüegg S, De Marchis GM, Tschudin-Sutter S, Sutter R. Predictors of infectious meningitis or encephalitis: the yield of cerebrospinal fluid in a cross-sectional study. BMC Infect Dis 2020; 20:304. [PMID: 32326881 PMCID: PMC7181581 DOI: 10.1186/s12879-020-05022-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. Methods Consecutive patients with meningitis and/or encephalitis form 2011–17 at a Swiss academic medical care center were included in this cross-sectional study. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. Infectious meningitis and/or encephalitis were defined as the composite outcome. For diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Multinomial logistic regression was performed to identify predictors of the composite outcome. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. An AUROC between 0.7–0.8 was defined as “good”, 08–0.9 as “excellent”, and > 0.9 as “outstanding”. Calibration was defined as “good” if the goodness of fit tests revealed insignificant p-values. Results Among 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Most frequent infectious pathogens were Streptococcus pneumoniae, Varicella zoster, and Herpes simplex 1&2. While in multivariable analysis lactate concentrations and decreased glucose ratios were the only independent predictors of bacterial infection (AUROCs 0.780, 0.870, and 0.834 respectively), increased CSF mononuclear cells were the only predictors of viral infections (AUROC 0.669). All predictors revealed good calibration. Conclusions Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. While increased CSF lactate and decreased glucose ratio are is the most reliable predictors of bacterial infections in patients with meningitis and/or encephalitis, only mononuclear cell counts predicted viral infections. Trial registration ClinicalTrials.gov identifier NCT03856528. Registered on February 26th 2019.
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Affiliation(s)
- Tolga Dittrich
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.,Medical faculty of the University of Basel, Basel, Switzerland
| | - Adrian Egli
- Medical faculty of the University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Medical faculty of the University of Basel, Basel, Switzerland.,Clinic for Intensive Care Medicine and Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Medical faculty of the University of Basel, Basel, Switzerland.,Clinic for Intensive Care Medicine and Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Medical faculty of the University of Basel, Basel, Switzerland.,Division of Infection Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. .,Medical faculty of the University of Basel, Basel, Switzerland. .,Clinic for Intensive Care Medicine and Department of Neurology, University Hospital Basel, Basel, Switzerland.
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Dittrich T, Marsch S, Rüegg S, De Marchis GM, Tschudin-Sutter S, Sutter R. Delirium in Meningitis and Encephalitis: Emergence and Prediction in a 6-Year Cohort. J Intensive Care Med 2020; 36:566-575. [PMID: 32193987 DOI: 10.1177/0885066620913004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVE Data regarding delirium in patients presenting with infections of the central nervous system, such as meningitis and/or encephalitis (ME), are scarce. We aimed to determine the frequency and early predictors of delirium in the acute phase of ME. METHODS We assessed clinical, radiologic, and laboratory data of patients with ME at a Swiss academic medical center from 2011 to 2017. The highest Intensive Care Delirium Screening Checklist (ICDSC) score was assessed within 24 hours around lumbar puncture. Multivariable logistic regression was performed to identify predictors of delirium (ICDSC ≥4). RESULTS Among 330 patients with ME, infectious pathogens were identified in 41%. An ICDSC >1 was found in 28% with and 19% without identified infectious pathogens. Delirium was diagnosed in 18% with and 14% without infectious pathogens and significantly associated with prolonged in-hospital treatment and mechanical ventilation, more frequent administration of neuroleptics and anesthetics (in 96% with delirium vs 35% without), complications, and less recovery to premorbid functional baseline. Low serum albumin at presentation was the only independent predictor of delirium (area under the receiver-operating curve [AUROC] = 0.792) in patients with pathogens. In patients with infections, the AUROC was smallest for encephalitis (AUROC = 0.641) and larger for patients with meningeal infections (meningitis AUROC = 0.807; meningoencephalitis AUROC = 0.896). CONCLUSIONS Delirium in the context of ME is seen in almost every fifth patient and linked to prolonged treatment, complications, and incomplete recovery. Among clinical, radiologic, and laboratory parameters, the good calibration and discrimination of low albumin serum concentrations for the prediction of delirium in patients with ME seem promising, especially if meninges are affected.
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Affiliation(s)
- Tolga Dittrich
- Clinic for Intensive Care Medicine, 30262University Hospital Basel, Switzerland
| | - Stephan Marsch
- Clinic for Intensive Care Medicine, 30262University Hospital Basel, Switzerland.,Faculty of Medicine, 30262University of Basel, Switzerland
| | - Stephan Rüegg
- Faculty of Medicine, 30262University of Basel, Switzerland.,Department of Neurology and Stroke Center, 30262University Hospital Basel, Switzerland
| | - Gian Marco De Marchis
- Faculty of Medicine, 30262University of Basel, Switzerland.,Department of Neurology and Stroke Center, 30262University Hospital Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Faculty of Medicine, 30262University of Basel, Switzerland.,Division of Infection Diseases and Hospital Epidemiology, 30262University Hospital Basel, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care Medicine, 30262University Hospital Basel, Switzerland.,Faculty of Medicine, 30262University of Basel, Switzerland.,Department of Neurology and Stroke Center, 30262University Hospital Basel, Switzerland
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Sharew A, Bodilsen J, Hansen BR, Nielsen H, Brandt CT. The cause of death in bacterial meningitis. BMC Infect Dis 2020; 20:182. [PMID: 32106821 PMCID: PMC7045616 DOI: 10.1186/s12879-020-4899-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background Death from bacterial meningitis is rarely attributed to the actual event causing death. The present study therefore categorized and characterized the cause and time of death due to bacterial meningitis. Methods In a cohort of patients > 15 years of age with community acquired bacterial meningitis the medical records were reviewed, and a clinical cause of death categorized into six main categories: 1) CNS complications, 2) Systemic complications, 3) Combination of systemic and CNS complications, 4) Sudden death, 5) Withdrawal of care, or 6) Unknown. Results We identified 358 patients of which 84 (23%) died in-hospital. Causes of death were ascribed to CNS complications in 43%, Systemic complications in 39%, Combined CNS and systemic complications in 4%, Sudden death in 7% and withdrawal of care in 5%. Brain herniation, circulatory failure, intractable seizures and other brain injury were the most common specific causes of death within 14 days from admission (55%). Conclusion Fatal complications due to the primary infection – meningitis - is most common within 14 days of admission. The diversity of complications causing death in meningitis suggest that determining the clinical cause of death is essential to the evaluation of novel treatment strategies.
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Affiliation(s)
- A Sharew
- Department of pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400, Hilleroed, Denmark
| | - J Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - B R Hansen
- Department of Infectious Diseases, University Hospital Copenhagen Hvidovre, Hvidovre, Denmark
| | - H Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C T Brandt
- Department of pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, 3400, Hilleroed, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Nordberg CL, Bodilsen J, Knudtzen FC, Storgaard M, Brandt C, Wiese L, Hansen BR, Andersen ÅB, Nielsen H, Lebech AM. Lyme neuroborreliosis in adults: A nationwide prospective cohort study. Ticks Tick Borne Dis 2020; 11:101411. [PMID: 32178995 DOI: 10.1016/j.ttbdis.2020.101411] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/23/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
The goal of this paper is to characterize the clinical presentation, serological results, current antibiotic treatment practice, including compliance with current European guidelines, and outcome in adults with Lyme neuroborreliosis (LNB) diagnosed at departments of infectious diseases in Denmark. Using a nationwide prospective cohort of patients with central nervous system infections, we identified all adults (≥ 18 years of age) treated for LNB at departments of infectious diseases in Denmark from 2015 through 2017. The database contains information on baseline demographics, history of tick bite, erythema migrans, clinical presentation, laboratory results of blood samples, and cerebrospinal (CSF) biochemistry (e.g. specific Borrelia burgdorferi sensu lato (s.l.) antibodies in serum, B. burgdorferi s.l. intrathecal antibody index) as well as antibiotic therapy. Outcome was assessed by the Glasgow Outcome Scale (GOS) and the presence of residual symptoms at follow-up one month after discharge. We included 194 LNB patients with a median age of 59 years (range 18-85 years, interquartile range [IQR] 47-69 years). The female-to-male ratio was 0.8. A total of 177 of 191 (93 %) of patients had early (second stage) LNB. A history of tick bite or erythema migrans was registered in 75 (39 %) and 49 (25 %) patients, respectively. The median duration of neurological symptoms before first hospital contact was 21 days (range 0-600 days, IQR 10-42 days). Predominant symptoms consisted of radicular pain in 135 of 194 (70 %), cranial nerve paresis in 88 of 194 (45 %), headache in 71 of 185 (38 %), and extremity paresis in 33 of 194 (17 %) patients. Serum-B. burgdorferi s.l. IgM and/or IgG antibodies were detectable in 166 of 181 (92 %) patients at the time of first CSF investigation. Median duration of antibiotic treatment was 14 days (range 10-35 days, IQR 14-21 days) and 59 (39 %) of the patients received intravenous ceftriaxone and/or benzylpenicillin G throughout treatment. At the 1-month follow-up, GOS was unfavorable (< 5) in 54 of 193 (28 %) patients. An unfavorable GOS score was more often registered in patients with ≥ 45 days of symptom duration (20 of 45 (44 %) vs. 34 of 145 (23 %); P = 0.006). In conclusion, a European cohort of adult patients with LNB diagnosed between 2015-2017 presented with classic symptoms and CSF findings. However, a substantial diagnostic delay was still observed. In disagreement with current guidelines, a substantial part of LNB patients were treated with antibiotics longer than 14 days and/or intravenously as route of administration.
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Affiliation(s)
- Cecilie Lerche Nordberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Fredrikke Christie Knudtzen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Infectious Diseases, Odense University Hospital, Denmark.
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
| | - Christian Brandt
- Department of Pulmonary and Infectious Diseases, Nordsjællands University Hospital, Hillerød, Denmark.
| | - Lothar Wiese
- Department of Infectious Diseases, Sjællands University Hospital, Roskilde, Denmark.
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Graf J, Hartmann CJ, Lehmann HC, Otto C, Adams O, Karenfort M, Schneider C, Ruprecht K, Bosse HM, Diedrich S, Böttcher S, Schnitzler A, Hartung HP, Aktas O, Albrecht P. Meningitis gone viral: description of the echovirus wave 2013 in Germany. BMC Infect Dis 2019; 19:1010. [PMID: 31783807 PMCID: PMC6883514 DOI: 10.1186/s12879-019-4635-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022] Open
Abstract
Background Aseptic meningitis epidemics may pose various health care challenges. Methods We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013 in order to scrutinize clinical differences from other aseptic meningitis cases. Results A total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 5.8% of all EV-positive cases which were voluntarily reported within the National Enterovirus surveillance (EVSurv, based on investigation of patients with suspected aseptic meningitis/encephalitis and/or acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were enterovirus positive and typed as echovirus (18 pediatric and 20 adult cases, median age 18.5 years; echovirus 18 (1), echovirus 2 (1), echovirus 30 (31), echovirus 33 (1), echovirus 9 (4)). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and 1 EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home. Conclusions Voluntary syndromic surveillance, such as provided by the EVSurv in our study may be a valuable tool for epidemiological research. Our analyses suggest that EV-positive meningitis predominantly affects younger patients and may be associated with a rather benign clinical course, compared to EV-negative cases.
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Affiliation(s)
- Jonas Graf
- Department of Neurology, University Hospital, Medical Faculty Heinrich-Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christian J Hartmann
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, University Hospital, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Carolin Otto
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ortwin Adams
- Institute of Virology, University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Karenfort
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Sabine Diedrich
- FG 15 Nationales Referenzzentrum für Poliomyelitis und Enteroviren, Robert Koch Institut, Berlin, Germany
| | - Sindy Böttcher
- FG 15 Nationales Referenzzentrum für Poliomyelitis und Enteroviren, Robert Koch Institut, Berlin, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, University Hospital, Medical Faculty Heinrich-Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, University Hospital, Medical Faculty Heinrich-Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, University Hospital, Medical Faculty Heinrich-Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Encephalitis and aseptic meningitis: short-term and long-term outcome, quality of life and neuropsychological functioning. Sci Rep 2019; 9:16158. [PMID: 31695095 PMCID: PMC6834582 DOI: 10.1038/s41598-019-52570-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022] Open
Abstract
For those surviving encephalitis, the influence on daily life of patients and their relatives may be substantial. In contrast, the prognosis after aseptic meningitis (ASM) is considered good. In this prospective study in patients with encephalitis (n = 20) and ASM (n = 46), we show that both groups experienced reduced Health Related Quality of Life (HRQoL) at two months after discharge, and that workability was reduced in 37% of the patients with ASM. However, 12 months after discharge no neuropsychological deficits were detected in the ASM group, whereas patients with encephalitis had lower scores on tests of fine motor and psychomotor skills as well as on learning and memory. We also found that for patients with encephalitis, neopterin, as a marker of Th1 cell induced macrophage activation, and a putatively neurotoxic ratio of the kynurenine pathway (KP) measured during the acute phase was associated with lower HRQoL. Our data show that not only encephalitis, but also ASM has substantial short-term influence on HRQoL and workability. For patients with encephalitis we suggest a link between immune activation and activation of the KP during the acute phase with impaired HRQoL.
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Huang Y, Dong S, Zhou L, Ma S, Wang Z, Jin X, Yang M. Early clinical management of acute CNS infections: a prospective cohort study. Future Microbiol 2019; 14:1309-1320. [PMID: 31661324 DOI: 10.2217/fmb-2019-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore early management and clinical predictors of patients with suspected CNS infections. Methods: In a prospective cohort study of 125 adult patients with suspected CNS infections, clinical features and early management time points were compared between groups with and without confirmed CNS infections. Results: The door-to-lumbar puncture time was associated with the initial Glasgow Coma Scale score, the confirmed diagnosis and the time to change empirical treatment. Multivariate analysis indicated that the initial Glasgow Coma Scale score was an independent risk factor for prognosis. Conclusion: Lumbar puncture plays a crucial role in early management of CNS infections. Patients with CNS infection who have disturbances of consciousness should receive particular attention.
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Affiliation(s)
- Yueying Huang
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Shuaiyue Dong
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Liangliang Zhou
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Senlin Ma
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Zongyan Wang
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Xin Jin
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
| | - Minjie Yang
- Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai 200040, PR China
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Meropenem versus Cefotaxime and Ampicillin as Empirical Antibiotic Treatment in Adult Bacterial Meningitis: a Quality Registry Study, 2008 to 2016. Antimicrob Agents Chemother 2019; 63:AAC.00883-19. [PMID: 31501148 DOI: 10.1128/aac.00883-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/22/2019] [Indexed: 11/20/2022] Open
Abstract
Cefotaxime, alone or with ampicillin, is frequently used in empirical treatment of acute bacterial meningitis (ABM). Meropenem is a less extensively investigated alternative. The aim of the study was to investigate the effects of empirical treatment with meropenem compared to cefotaxime plus ampicillin on outcome in ABM. The study was based on data from the Swedish quality register for ABM collected between January 2008 and December 2016. Propensity score matching was performed to adjust for baseline differences between the groups. Mortality within 30 days was the primary outcome. The treatment regimens of interest were administered to 623 patients; 328 were given cefotaxime plus ampicillin whereas 295 received meropenem. Using propensity score matching, the 30-day mortality rates were 3.2% in the cefotaxime plus ampicillin group and 3.6% in the meropenem group. For matched cases, the odds ratio (OR) for 30-day mortality for meropenem versus cefotaxime plus ampicillin was 1.15 (confidence interval [CI], 0.41 to 3.22; P = 0.79). The OR for 90-day mortality was 1.47 (CI, 0.62 to 3.52; P = 0.38) and for unfavorable outcome was 1.10 (CI, 0.75 to 1.63; P = 0.62). The findings of our study indicate that meropenem is an effective empirical treatment option for adults with community-acquired ABM. However, to spare carbapenems, guidelines should continue to recommend third-generation cephalosporins as an empirical treatment for the majority of patients with ABM.
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Kjærgaard N, Bodilsen J, Justesen US, Schønheyder HC, Andersen CØ, Ellermann-Eriksen S, Dzajic E, Chen M, Møller JK, Dessau RB, Frimodt-Møller N, Jarløv JO, Nielsen H. Community-acquired meningitis caused by beta-haemolytic streptococci in adults: a nationwide population-based cohort study. Eur J Clin Microbiol Infect Dis 2019; 38:2305-2310. [PMID: 31440914 DOI: 10.1007/s10096-019-03678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine the clinical presentation of community-acquired beta-haemolytic streptococcal (BHS) meningitis in adults. This is a nationwide population-based cohort study of adults (≥ 16 years) with BHS meningitis verified by culture or polymerase chain reaction of the cerebrospinal fluid (CSF) from 1993 to 2005. We retrospectively evaluated clinical and laboratory features and assessed outcome by Glasgow Outcome Scale (GOS). We identified 54 adults (58% female) with a median age of 65 years (IQR 55-73). Mean incidence rate was 0.7 cases per 1,000,000 person-years. Alcohol abuse was noted among 11 (20%) patients. Group A streptococci (GAS) were found in 17 (32%) patients, group B (GBS) in 18 (34%), group C (GCS) in four (8%) and group G (GGS) in 14 (26%). Patients with GAS meningitis often had concomitant otitis media (47%) and mastoiditis (30%). Among patients with GBS, GCS or GGS meningitis, the most frequent concomitant focal infections were bone and soft tissue infections (19%) and endocarditis (16%). In-hospital mortality was 31% (95% CI 19-45), and 63% (95% CI 49-76) had an unfavourable outcome at discharge (GOS < 5). BHS meningitis in adults is primarily observed among the elderly and has a poor prognosis. GAS meningitis is primarily associated with concomitant ear-nose-throat infection.
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Affiliation(s)
- Nicolai Kjærgaard
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark
| | - Ulrik Stenz Justesen
- Department of Clinical Microbiology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | | | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Esad Dzajic
- Department of Clinical Microbiology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700, Esbjerg, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, DK-6400, Sonderborg, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Sygehus Lillebælt, Kabbeltoft 25, DK-7100, Vejle, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 30, DK-4200, Slagelse, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Henrik Nielsen
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark
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Larsen FTBD, Brandt CT, larsen L, Klastrup V, Wiese L, Helweg-Larsen J, Riber M, Hansen BR, Østergaard Andersen C, Nielsen H, Bodilsen J. Risk factors and prognosis of seizures in adults with community-acquired bacterial meningitis in Denmark: observational cohort studies. BMJ Open 2019; 9:e030263. [PMID: 31266843 PMCID: PMC6609062 DOI: 10.1136/bmjopen-2019-030263] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine predefined risk factors and outcome of seizures in community-acquired bacterial meningitis (CABM). DESIGN Observational cohort studies SETTING: Denmark PARTICIPANTS: In the derivation cohort, we retrospectively included all adults (>15 years of age) with CABM in North Denmark Region from 1998 to 2014 and at Hvidovre and Hillerød hospitals from 2003 to 2014. In the validation cohort, we prospectively included all adults (>18 years of age) with CABM treated at all departments of infectious diseases in Denmark from 2015 to 2017. PRIMARY AND SECONDARY OUTCOME MEASURES In the derivation cohort, we used modified Poisson regression to compute adjusted relative risks (RRs) with 95% confidence intervals for predefined risk factors for seizures during CABM as well as for risks of death and unfavourable outcome assessed by the Glasgow Outcome Scale score (1-4). Next, results were validated in the validation cohort. RESULTS In the derivation cohort (n=358), risk factors for seizures at any time were pneumococcal aetiology (RR 1.69, 1.01-2.83) and abnormal cranial imaging (RR 2.27, 1.46-3.53), while the impact of age >65 years and immunocompromise was more uncertain. Examining seizures occurring after admission, risk factors were abnormal cranial imaging (RR 2.23, 1.40-3.54) and immunocompromise (RR 1.59, 1.01-2.50). Seizures at any time were associated with increased risks of in-hospital mortality (RR 1.45, 1.01-2.09) and unfavourable outcome at discharge (RR 1.27, 1.02-1.60). In the validation cohort (n=379), pneumococcal aetiology (RR 1.69, 1.10-2.59) and abnormal cranial imaging (RR 1.68, 1.09-2.59) were confirmed as risk factors for seizures at any time. For seizures occurring after admission, only pneumococcal meningitis (RR 1.92, 1.12-3.29) remained significant. Seizures at any time were also associated with in-hospital mortality (RR 3.26, 1.83-5.80) and unfavourable outcome (RR 1.23, 1.00-1.52) in this cohort. CONCLUSIONS Pneumococcal aetiology, immunocompromise and abnormal cranial imaging were risk factors for seizures in CABM. Seizures were strongly associated with mortality and unfavourable outcome.
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Affiliation(s)
| | | | - Lykke larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Vibeke Klastrup
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjællands Universitetshospital Roskilde, Roskilde, Denmark
| | | | - Mette Riber
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | | | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Hsu MH, Hsu JF, Kuo HC, Lai MY, Chiang MC, Lin YJ, Huang HR, Chu SM, Tsai MH. Neurological Complications in Young Infants With Acute Bacterial Meningitis. Front Neurol 2018; 9:903. [PMID: 30405525 PMCID: PMC6207629 DOI: 10.3389/fneur.2018.00903] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 01/27/2023] Open
Abstract
We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes. Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.
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Affiliation(s)
- Mei-Hsin Hsu
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan-Chang Kuo
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Meiho University, Ping Tung, Taiwan
| | - Mei-Yin Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Jui Lin
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
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PECULIARITIES OF CLINICAL MANIFESTATIONS OF CNS INFECTIONS IN CHILDREN. ACTA BIOMEDICA SCIENTIFICA 2018. [DOI: 10.29413/abs.2018-3.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
At present, the neuroinfections in children are a socially significant problem, as they can lead to disability and death.Aim. To reveal the patterns of clinical manifestations of neuroinfections in the children’s central nervous system.Materials and methods. We investigated 91 cases of neuroinfections in children. The children underwent treatment in the Regional Infectious Diseases Hospital (Chita) between 2007 and 2014. Among 91 cases, 32 patients had viral neuroinfections and 59 had bacterial infections.Results. The young boys have bacterial neuroinfections more often. Headaches were found in 73.6 % of children; more often in children with viral neuroinfections – in 87.5 %, and less frequent in children with bacterial neuroinfections – in 66.1 %, p ˂ 0.01 The disease often starts with fever and vomiting. The neck stiffness and the Kernig symptom were often found in patients with bacterial neuroinfections persisting for 5 ± 1.7 days and 4 ± 1.9 days correspondingly, in children with viral neuroinfections – for 3 ± 1.4 and 3 ± 1.2 days, p ˂ 0.05. Pneumococcal etiology of the disease underlies the most severe and protracted cases in the course of neuroinfections. Pneumococcus causes the most severe and protracted diseases of the nervous system. Most often the bacterial neuroinfections cause cerebral edema and septic shock.Conclusions. Neuroinfections have typical clinical signs that need to be properly interpreted and evaluated by physicians to reduce adverse outcomes.
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