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Skudal H, Lorentzen ÅR, Stenstad T, Quist-Paulsen E, Egeland J, Fevang B, Jaioun K, Hansen BÅ, Solheim AM, Tveten Y, Veje M, Eikeland R, Kersten H. Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022. Eur J Clin Microbiol Infect Dis 2024; 43:1355-1366. [PMID: 38801484 PMCID: PMC11271349 DOI: 10.1007/s10096-024-04855-2] [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: 11/19/2023] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE). METHODS This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified. RESULTS Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease. CONCLUSION This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease. TRIAL REGISTRATION Prosjekt #2,296,959 - The Norwegian Tick-borne Encephalitis Study - NOTES. Acute phase characteristics and long-term outcomes. - Cristin.
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Affiliation(s)
- Hilde Skudal
- Department of Infectious Diseases, Telemark Hospital Trust, Skien, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway.
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Tore Stenstad
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Department of Rheumatology Dermatology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Keson Jaioun
- Department of Research, Telemark Hospital Trust, Skien, Norway
| | - Bjørn Åsheim Hansen
- Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marit Solheim
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngvar Tveten
- Department of Clinical Microbiology, Telemark Hospital Trust, Skien, Norway
| | - Malin Veje
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Randi Eikeland
- Norwegian National Advisory Unit on Tick-borne Diseases, Sørlandet Hospital Trust, Kristiansand, Norway
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hege Kersten
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Research, Telemark Hospital Trust, Skien, Norway
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Hatami-Fard G, Anastasova-Ivanova S. Advancements in Cerebrospinal Fluid Biosensors: Bridging the Gap from Early Diagnosis to the Detection of Rare Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:3294. [PMID: 38894085 PMCID: PMC11174891 DOI: 10.3390/s24113294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024]
Abstract
Cerebrospinal fluid (CSF) is a body fluid that can be used for the diagnosis of various diseases. However, CSF collection requires an invasive and painful procedure called a lumbar puncture (LP). This procedure is applied to any patient with a known risk of central nervous system (CNS) damage or neurodegenerative disease, regardless of their age range. Hence, this can be a very painful procedure, especially in infants and elderly patients. On the other hand, the detection of disease biomarkers in CSF makes diagnoses as accurate as possible. This review aims to explore novel electrochemical biosensing platforms that have impacted biomedical science. Biosensors have emerged as techniques to accelerate the detection of known biomarkers in body fluids such as CSF. Biosensors can be designed and modified in various ways and shapes according to their ultimate applications to detect and quantify biomarkers of interest. This process can also significantly influence the detection and diagnosis of CSF. Hence, it is important to understand the role of this technology in the rapidly progressing field of biomedical science.
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Affiliation(s)
- Ghazal Hatami-Fard
- The Hamlyn Centre, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
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Matsuki Y, Oda T, Fukao E, Sugiura A, Yokozawa T, Honma Y. Prognostic Factors for Japanese Adults With Acute Community-Acquired Bacterial Meningitis: A Retrospective Study. Cureus 2024; 16:e57642. [PMID: 38707085 PMCID: PMC11070060 DOI: 10.7759/cureus.57642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Background This study aimed to determine if the cerebrospinal fluid (CSF) cell count is useful for predicting the infection severity or prognosis in Japanese adults with community-acquired bacterial meningitis. Methodology This study retrospectively evaluated the prognosis of patients diagnosed with community-acquired bacterial meningitis at our hospital from January 2004 to December 2021 using the modified Rankin scale (mRs) (Showa General Hospital; N = 39). Patients were classified into the following two groups: (i) favorable (mRs: 0-3) and (ii) unfavorable (mRs: 4-6). Eight factors were selected and compared with outcomes, and then two factors were evaluated from those, and a multivariate logistic regression was used to determine the significant variables. Results CSF cell count was observed to be associated with poor prognoses (odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.99995-0.99999, p = 0.0012). Glasgow coma scale (GCS) score on admission was also observed to be associated with poor prognoses (OR = 0.93, 95% CI = 0.89145-0.97290, p = 0.0029). Conclusions Low CSF cell count and low GCS on admission were observed as risk factors for poor prognoses in patients with bacterial meningitis.
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Affiliation(s)
| | - Toshimi Oda
- Infectious Diseases, Showa General Hospital, Tokyo, JPN
| | - Eri Fukao
- Neurology, Showa General Hospital, Tokyo, JPN
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Neumann B, Hierl A, Wunderlich S, Meier H, Bauer C, Gerner ST, Rieder G, Geis T, Kunkel J, Bauswein M, Niller HH, Schmidt B, Rubbenstroth D, Beer M, Linker RA, Jantsch J, Angstwurm K. Cerebrospinal fluid in Borna disease virus 1 (BoDV-1) encephalitis. J Neurol Sci 2023; 446:120568. [PMID: 36716549 DOI: 10.1016/j.jns.2023.120568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
Borna disease virus 1 (BoDV-1) has been recognized as a rare cause of very severe encephalitis with rapid onset in central Europe. Data on cerebrospinal fluid (CSF) analysis have not yet been analyzed in detail. Here, we present the first study on CSF changes in BoDV-1 encephalitis. We retrospectively analyzed CSFs from 18 BoDV-1 encephalitis cases from Bavaria, Germany, an endemic region, from 1996 to 2021. Data were obtained through review of medical records and institutional databases. We found that white blood cell count (WBC) in CSF is elevated in 13 of our 18 patients at first examination (average 83.2 ± 142.3 leukocytes/μl) and cytology showed predominance of lymphocytes. Patients with typical symptoms of meningoencephalitis had higher WBC in first CSF analyzation (133.5 ± 163.1 vs 4.0 ± 3.2/μl; p = 0.065). BoDV-1 PCR of CSF is not always positive when tested (7 of 9 cases). Four of five patients tested showed a polyvalent reaction against multiple viruses in the CSF suggesting that BoDV-1 may trigger autoimmune mechanisms. CSF changes in BoDV-1 encephalitis seem similar to those of other viral encephalitis and at the beginning WBC can be normal in up to 28%, making the diagnosis even more challenging. All in all, BoDV-1 should be included in the diagnostic workup of patients with rapidly evolving and/or severe encephalitis and patients with severe neuropathy and secondary encephalopathy with and without CSF changes. Repeated CSF examinations as well as BoDV-1 serology and CSF PCR have to be considered in endemic areas.
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Affiliation(s)
- Bernhard Neumann
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany; Department of Neurology, Donau-Isar-Klinikum Deggendorf, Deggendorf, Germany
| | - Andreas Hierl
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar der TU Muenchen, Muenchen, Germany
| | - Helen Meier
- Department of Neurology, Paracelsus Medizinische Privatuniversitaet, Klinikum Nürnberg, Nürnberg, Germany
| | - Christina Bauer
- Department of Neurology, Paracelsus Medizinische Privatuniversitaet, Klinikum Nürnberg, Nürnberg, Germany
| | - Stefan T Gerner
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Georg Rieder
- Department of Neurology, Klinikum Traunstein, Traunstein, Germany
| | - Tobias Geis
- University Children's Hospital Regensburg (KUNO-Clinics) at St Hedwig Hospital, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Jürgen Kunkel
- University Children's Hospital of Regensburg (KUNO), Regensburg, Germany
| | - Markus Bauswein
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Hans Helmut Niller
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Dennis Rubbenstroth
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany
| | - Martin Beer
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, University Hospital Cologne, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany.
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Guerra M, Marado D, Fortuna J. Acute meningitis complicated with ventriculitis caused by Streptococcus dysgalactiae subsp. dysgalactiae. Arch Clin Cases 2023; 10:11-14. [PMID: 36814676 PMCID: PMC9940286 DOI: 10.22551/2023.38.1001.10231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Streptococcus dysgalactiae subspecies dysgalactiae (SDSD), also known as Lancefield group C streptococcus, is a pathogen found in animals. It is known to cause pyogenic infections in animals and is one of the most common pathogens that can cause mastitis in cattle. Very few reports of SDSD causing human diseases to have been reported in the literature, but we report a case of community-acquired meningitis and pyogenic ventriculitis caused by SDSD. This report is the first case of SDSD causing a central nervous system (CNS) infection in humans and aims to raise awareness about the role of SDSD in CNS infections. It also seeks to promote the recognition of this bacteria as a potential cause of invasive diseases.
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Affiliation(s)
- Mariana Guerra
- Correspondence: Mariana Guerra. Department of Internal Medicine, Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal.
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Sinaei R, Nejadbiglari H, Sinaei R, Zeinaly M, Pezeshki S, Jafari M. Finding positive SARS-CoV-2 RT-PCR in cerebrospinal fluid of two pediatric patients with severe COVID-19: a brief case report. BMC Pediatr 2023; 23:49. [PMID: 36717816 PMCID: PMC9885917 DOI: 10.1186/s12887-022-03806-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 12/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is growing evidence of nervous system involvement and related complaints in children with coronavirus disease 2019 (COVID-19). However, it seems that attempts to track of the virus in the nervous system have so far been unsuccessful. CASE PRESENTATION Here we describe two pediatric cases of severe COVID-19 who had positive cerebrospinal fluid (CSF) and nasopharyngeal polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2). A 36-month-old girl who presented with fever, diarrhea, mild left ventricular dysfunction and bizarre movements, and a five-month-old boy who presented with fever, watery diarrhea, severe dehydration, mottling, and two episodes of seizure. Their CSF analyses and cultures were normal. They admitted in intensive care unit (ICU) for near four days and discharged after ten days without any complaint. CONCLUSION This is one of the first reports of the presence of coronavirus in the central nervous system in COVID-19 pediatric patients, emphasizing the neurotropism and neuroinvasion characteristics of the virus.
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Affiliation(s)
- Reza Sinaei
- grid.412105.30000 0001 2092 9755Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran ,grid.412105.30000 0001 2092 9755Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Habibeh Nejadbiglari
- grid.412105.30000 0001 2092 9755Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Roya Sinaei
- grid.411705.60000 0001 0166 0922Department of Pediatric Neurology, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran ,grid.412105.30000 0001 2092 9755Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran
| | - Maziar Zeinaly
- grid.412105.30000 0001 2092 9755Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- grid.412105.30000 0001 2092 9755Department of Internal Medicine, Kerman University of Medical Sciences, Kerman, Iran ,grid.412105.30000 0001 2092 9755Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Maedeh Jafari
- grid.412105.30000 0001 2092 9755Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran ,grid.412105.30000 0001 2092 9755Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Clinical, Imaging, and Prognostic Differences of Neurosyphilis in HIV and Non-HIV Individuals. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Etiology and Risk Factors for Admission to the Pediatric Intensive Care Unit in Children With Encephalitis in a Developing Country. Pediatr Infect Dis J 2022; 41:806-812. [PMID: 35830514 DOI: 10.1097/inf.0000000000003637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). STUDY DESIGN Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. RESULTS Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. CONCLUSIONS Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.
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Carta S, Ferraro D, Ferrari S, Briani C, Mariotto S. Oligoclonal bands: clinical utility and interpretation cues. Crit Rev Clin Lab Sci 2022; 59:391-404. [DOI: 10.1080/10408363.2022.2039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sara Carta
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Diana Ferraro
- Department of Biomedicine, Metabolic, and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Sara Mariotto
- Department of Neurosciences, Biomedicine, and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola. Pediatr Infect Dis J 2021; 40:e462-e465. [PMID: 34561386 DOI: 10.1097/inf.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The diagnosis of bacterial meningitis (BM) is problematic in young infants, as clinical features may be nonspecific or even absent. Cerebrospinal fluid (CSF) analysis usually confirms the diagnosis, but the CSF parameters can be normal also in culture-proven BM. Our objective was to identify the clinical and CSF indices, that quickly and without laboratory likely lead to the diagnosis of confirmed of probable BM in young infants in Angola. METHODS We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Pediatric Hospital of Luanda. All assessed infants showed symptoms and signs compatible of BM or neonatal sepsis and were <90 days of age. RESULTS Of the 1088 infants, 212 (19%) showed bacteria in CSF, while 88 (8%) had probable BM. Independent clinical indicators of BM were not-clear CSF, seizures, weight <2500 g and illness >7 days. In infants with BM, CSF leukocytes were >10 × 106/L in 46%, CSF glucose <25 mg/dL in 43% and CSF protein >120 mg/dL in 58%. All measured parameters were in normal range in 25% of patients. In 515 infants with normal CSF parameters, bacteria were found in 74 (14%). In these infants, illness >7 days, weight <2500 g and malnutrition increased the probability of BM. CONCLUSIONS Our study confirms and underlines the problems in diagnosing BM in young infants. While the CSF parameters were normal in 25% of infants, the easily recognizable unclear appearance of CSF was the single strongest predictor of BM.
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Diagnosis of Creutzfeldt-Jakob disease after neurosyphilis: just bad luck or misdiagnosed? Acta Neurol Belg 2021; 121:1083-1085. [PMID: 34309786 DOI: 10.1007/s13760-021-01722-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
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Kamal YM, Abdelmajid Y, Al Madani AAR. Cerebrospinal fluid confirmed COVID-19-associated encephalitis treated successfully. BMJ Case Rep 2020; 13:13/9/e237378. [PMID: 32938656 PMCID: PMC7497137 DOI: 10.1136/bcr-2020-237378] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19’s classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.
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Posnakoglou L, Siahanidou T, Syriopoulou V, Michos A. Impact of cerebrospinal fluid syndromic testing in the management of children with suspected central nervous system infection. Eur J Clin Microbiol Infect Dis 2020; 39:2379-2386. [PMID: 32683594 DOI: 10.1007/s10096-020-03986-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022]
Abstract
The aim of the study was to evaluate the impact of the use of BioFire® FilmArray® meningitis/encephalitis(FA-ME) panel which enables rapid automated CSF testing for 14 common viral, bacterial, and yeast pathogens that cause CNS infections, in the management of children with suspected CNS infection. A prospective cohort study was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year, with possible CNS infection and CSF pleocytosis (> 15 cells/mm3). Children were randomized 1:1, either to use FA-ME or separate molecular CSF microbiological tests according to usual pediatric practice in the hospital. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. A total of 142 children were included in the study (71 cases). A pathogen was detected in 37/71(52.1%) children with the use of FA-ME and in 16/71(22.5%) in the control group (P value < 0.001). In aseptic meningitis cases a virus was detected in 27/61(44.2%) and in 11/66(16.7%) controls (P value < 0.001). Median (IQR) length of stay in cases and controls with aseptic meningitis was 5(4-8) and 8(6-10) days, respectively (P value < 0. 001). The median (IQR) duration of antimicrobials in cases and controls was 4(2-5.7) and 7(5-10) days, respectively (P value < 0.001). The hospitalization cost was calculated in cases and controls 1042€ (932-1372) and 1522€ (1302-1742), respectively (P value < 0.001). The use of FA-ME was able to reduce significantly the use of antimicrobials, the hospitalization days, and the total cost comparing to the control group in children with suspected CNS infection.
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Affiliation(s)
- Lamprini Posnakoglou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Vasiliki Syriopoulou
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, Goudi, 11527, Athens, Greece.
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Abstract
PURPOSE OF REVIEW Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens. RECENT FINDINGS Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic therapy impacts the yield of microbiological results. Delaying antibiotic therapy is associated with worse clinical outcomes. Adjunctive steroids have reduced the mortality of adults with pneumococcal meningitis but have been associated with increased adverse outcomes in Listeria monocytogenes and Cryptococcus neoformans. SUMMARY Community-acquired bacterial meningitis remains a global health concern with high morbidity and mortality especially in low-income countries. Cranial imaging should be done only in patients with an indication with an attempt to do a prompt lumbar puncture and to initiate antibiotic therapy and adjunctive steroids as soon as possible to improve clinical outcomes.
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The Cerebrospinal Fluid Interleukin-6/Interleukin-10 Ratio Differentiates Pediatric Tick-borne Infections. Pediatr Infect Dis J 2020; 39:239-243. [PMID: 32032308 DOI: 10.1097/inf.0000000000002552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Borrelia burgdorferi and tick-borne encephalitis (TBE) virus are 2 types of tick-borne pathogens that can cause central nervous system infection. Routine diagnostics have so far included analysis of cerebrospinal fluid (CSF) cell numbers, CSF serology for Borrelia burgdorferi and serum serology for TBE virus. However, early diagnosis may be difficult based on antibody detection which takes time to analyze, and with the possibility of false negative results, thus delaying treatment. Cytokine analyses are becoming increasingly available in clinical routine care and may offer important information. METHODS Fifteen cytokines and chemokines were measured in the CSF from the diagnostic lumbar puncture of 37 children with TBE, 34 children with neuroborreliosis and 19 children without evidence of central nervous system infection, using Luminex technology. RESULTS Significantly higher levels of proinflammatory interleukin-6 were detected in the samples from TBE-infected children, when compared with neuroborreliosis or controls. In comparison, children with neuroborreliosis had significantly higher levels of interleukin-7, interleukin-8, interleukin-10, and interleukin-13 when compared with TBE infected or controls. Furthermore, the ratio between interleukin-6 and interleukin-10 was significantly different between the 2 types of tick-borne infections. CONCLUSIONS The interleukin-6/interleukin-10 ratio can be used as a rapid diagnostic cue upon suspected tick-borne infection, enabling fast and correct treatment. Also, in serology-negative results, such information may strengthen a clinical suspicion.
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Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray Meningitis/Encephalitis Panel Utilization in Pediatric Patients. J Clin Microbiol 2020; 58:JCM.01592-19. [PMID: 31852767 DOI: 10.1128/jcm.01592-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 01/06/2023] Open
Abstract
Molecular testing of cerebrospinal fluid (CSF) using the BioFire FilmArray meningitis/encephalitis (FA-M/E) panel permits rapid, simultaneous pathogen detection. Due to the broad spectrum of targeted organisms, FA-M/E testing may be restricted to patients with abnormal CSF findings. We sought to determine if restriction is appropriate in our previously healthy and/or immunocompromised pediatric patients. FA-M/E was ordered on 1,025 CSF samples from 948 patients; 121 (11.8%) specimens were FA-M/E positive. Of these, 89 (73.6%) were virus positive, and 30 (24.8%) were bacterium positive. The most common targets detected were enterovirus (n = 38), human herpesvirus 6 (HHV-6) (n = 30), and Streptococcus pneumoniae (n = 14). Pleocytosis with white blood cell (WBC) levels of ≥5 cells/mm3 and ≥10 cells/mm3 were found in 33.1% and 24.3% of all specimens, respectively. Using WBC levels of ≥5 cells/mm3, 63.4% (59/93) of positive specimens exhibited pleocytosis, compared to 29.5% (233/789) of negative specimens. Among positive specimens, 54.4% (37/68) of viral and 87% (20/23) of bacterial cases had pleocytosis. The use of a pleocytosis cutoff of ≥10 cells/mm3 would have missed an additional enterovirus, one cytomegalovirus (CMV), and two HHV-6 diagnoses. CSF glucose and protein levels were normal for 83/116 (75.2%) and 51/116 (44%) positive specimens. Abnormal glucose in combination with WBC levels of ≥10 cells/mm3 showed high specificity (94.5%) and was a better predictor of FA-M/E positivity than abnormal protein. Sensitivity and positive predictive values were <90% for all biomarkers. CSF pleocytosis and abnormal glucose/protein were poor predictors of FA-M/E. Restricting FA-M/E orders based on pleocytosis or other abnormal parameters would have resulted in missed diagnostic opportunities, particularly for the detection of viruses in both previously healthy and immunocompromised patients.
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Duff S, Hasbun R, Balada-Llasat JM, Zimmer L, Bozzette SA, Ginocchio CC. Economic analysis of rapid multiplex polymerase chain reaction testing for meningitis/encephalitis in adult patients. Infection 2019; 47:945-953. [PMID: 31111325 DOI: 10.1007/s15010-019-01320-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/11/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Many patients with suspected meningitis do not require hospitalization yet are admitted, often resulting in unnecessary care and additional cost. We assessed the possible economic impact of a rapid multiplex test for suspected adult community-acquired meningitis/encephalitis. METHODS A model simulated diagnosis, clinical decisions, resource use/costs of standard of care (SOC) and two cerebrospinal fluid (CSF) testing strategies using the FDA-cleared BioFire® FilmArray® System (FA) which provides results in approximately one hour. RESULTS Pathogens detected by FA caused approximately 74% of cases, 97% of which would be accurately diagnosed with FA. False positives and false negatives more often led to extended/unnecessary admission than inappropriate discharge/missed admission. Mean cost per case ranged from 16829 to 20791. A strategy of testing all suspected cases yielded greater savings (2213/case) than testing only those with abnormal CSF (812/case) and both were less expensive than SOC. CONCLUSION This economic analysis demonstrates that FA can inform more appropriate clinician decisions resulting in cost savings with greater economic benefits achievable with syndromic testing of all cases, rather than SOC or targeted syndromic testing.
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Affiliation(s)
- Steve Duff
- Veritas Health Economics Consulting, 8033 Corte Sasafras, Carlsbad, CA, 92009, USA.
| | | | | | | | - Samuel A Bozzette
- bioMérieux, Durham, NC, USA.,University of California, San Diego, La Jolla, CA, USA
| | - Christine C Ginocchio
- bioMérieux, Durham, NC, USA.,Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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18
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Okazaki Y, Higashi Y. Unusual cause of progressively impaired cognitive function: Mycobacterium avium complex meningoencephalitis. BMJ Case Rep 2019; 12:12/4/e229022. [PMID: 30948407 DOI: 10.1136/bcr-2018-229022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium avium complex (MAC) is a rare cause of meningoencephalitis. Non-tuberculous mycobacterium meningoencephalitis including MAC meningoencephalitis is an important cause of rapidly progressive dementia. We present a case of MAC meningoencephalitis in an immunosuppressed woman who had progressively impaired cognitive function. An 83-year-old woman who had been taking glucocorticoid for myasthenia gravis developed cognitive dysfunction and visual hallucinations over a period of 2 weeks. Cerebrospinal fluid (CSF) findings were normal, but MAC was positive in CSF culture and M. avium and M. intracellulare were identified by PCR. She was treated with multiple antimycobacterial agents and her symptoms fully recovered. MAC meningoencephalitis is an unusual cause of progressively impaired cognitive function. The possibility of mycobacterial central nervous system infection cannot be excluded by normal CSF findings.
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Affiliation(s)
- Yuji Okazaki
- Department of Internal Medicine, Akiota Hospital, Yamagata-gun, Hiroshima, Japan
| | - Yusuke Higashi
- Department of Internal Medicine, Akiota Hospital, Yamagata-gun, Hiroshima, Japan
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Missing Cases of Herpes Simplex Virus (HSV) Infection of the Central Nervous System When the Reller Criteria Are Applied for HSV PCR Testing: a Multicenter Study. J Clin Microbiol 2019; 57:JCM.01719-18. [PMID: 30487303 DOI: 10.1128/jcm.01719-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022] Open
Abstract
Previous studies suggested that herpes simplex virus (HSV) PCR testing can be safely deferred in patients with normal cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein levels as long as they are older than 2 years of age and are not immunocompromised, the so-called Reller criteria. In this multicenter study, we retrospectively assessed the validity of these screening criteria in our setting. A total of 4,404 CSF specimens submitted for HSV PCR testing to the respective microbiology laboratories at the participating hospitals between 2012 and 2018 were included. Six commercially available HSV PCR assays were used across the participating centers. Ninety-one of the 4,404 CSF specimens (2.1%) tested were positive for HSV DNA (75 samples for HSV-1 and 16 for HSV-2). Nine patients failed to meet the Reller criteria, of whom seven were deemed to truly have HSV encephalitis. Overall, no significant correlation between HSV PCR cycle threshold (CT ) values and WBC counts or total protein levels was found. In addition, median HSV PCR CT s were comparable between patients who met the Reller criteria and those who did not (P = 0.531). In summary, we show that HSV DNA may be detected in CSF specimens with normal WBC and protein levels collected from immunocompetent individuals older than 2 years with HSV encephalitis. Nevertheless, the data also indicate that the number of cases detected could be lowered at least by half if CSF specimens with borderline WBC counts (4 cells/mm3) as well as children of any age are systematically tested.
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Hasbun R, Balada-Llasat JM, Duff S. Letter to the Editor reply: economic model of the FilmArray Meningitis Encephalitis panel in children. Future Microbiol 2018; 13:1555-1556. [DOI: 10.2217/fmb-2018-0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rodrigo Hasbun
- UTHealth McGovern Medical School; Houston, TX, 770302, USA
| | | | - Steve Duff
- Veritas Health Economics Consulting; Carlsbad, CA, 92009, USA
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21
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Ahlbrecht J, Hillebrand LK, Schwenkenbecher P, Ganzenmueller T, Heim A, Wurster U, Stangel M, Sühs KW, Skripuletz T. Cerebrospinal fluid features in adults with enteroviral nervous system infection. Int J Infect Dis 2018; 68:94-101. [DOI: 10.1016/j.ijid.2018.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 12/16/2022] Open
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22
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Cresswell FV, Bangdiwala AS, Meya DB, Bahr NC, Vidal JE, Török ME, Thao LTP, Thwaites GE, Boulware DR. Absence of cerebrospinal fluid pleocytosis in tuberculous meningitis is a common occurrence in HIV co-infection and a predictor of poor outcomes. Int J Infect Dis 2018; 68:77-78. [PMID: 29391245 DOI: 10.1016/j.ijid.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Fiona V Cresswell
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Infectious Diseases Institute, Kampala, Uganda.
| | | | - David B Meya
- Infectious Diseases Institute, Kampala, Uganda; College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS, USA
| | - Jose E Vidal
- Department of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratório de Investigação Médica 49, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - M Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - David R Boulware
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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