1
|
Sun P, Yang Y, Yang L, Qian Y, Liang M, Chen H, Zhang J, Qiu Y, Guo L, Fu S. Quercetin Protects Blood-Brain Barrier Integrity via the PI3K/Akt/Erk Signaling Pathway in a Mouse Model of Meningitis Induced by Glaesserella parasuis. Biomolecules 2024; 14:696. [PMID: 38927100 DOI: 10.3390/biom14060696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Glaesserella parasuis (G. parasuis) causes serious inflammation and meningitis in piglets. Quercetin has anti-inflammatory and anti-bacterial activities; however, whether quercetin can alleviate brain inflammation and provide protective effects during G. parasuis infection has not been studied. Here, we established a mouse model of G. parasuis infection in vivo and in vitro to investigate transcriptome changes in the mouse cerebrum and determine the protective effects of quercetin on brain inflammation and blood-brain barrier (BBB) integrity during G. parasuis infection. The results showed that G. parasuis induced brain inflammation, destroyed BBB integrity, and suppressed PI3K/Akt/Erk signaling-pathway activation in mice. Quercetin decreased the expression of inflammatory cytokines (Il-18, Il-6, Il-8, and Tnf-α) and BBB-permeability marker genes (Mmp9, Vegf, Ang-2, and Et-1), increased the expression of angiogenetic genes (Sema4D and PlexinB1), reduced G. parasuis-induced tight junction disruption, and reactivated G. parasuis-induced suppression of the PI3K/Akt/Erk signaling pathway in vitro. Thus, we concluded that quercetin may protect BBB integrity via the PI3K/Akt/Erk signaling pathway during G. parasuis infection. This was the first attempt to explore the protective effects of quercetin on brain inflammation and BBB integrity in a G. parasuis-infected mouse model. Our findings indicated that quercetin is a promising natural agent for the prevention and treatment of G. parasuis infection.
Collapse
Affiliation(s)
- Peiyan Sun
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
| | - Yaqiong Yang
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
| | - Linrong Yang
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
| | - Yuanzhuo Qian
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
| | - Mingxia Liang
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
| | - Hongbo Chen
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan 430023, China
- Hubei Provincial Center of Technology Innovation for Domestic Animal Breeding, Wuhan 430023, China
| | - Jing Zhang
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan 430023, China
- Hubei Provincial Center of Technology Innovation for Domestic Animal Breeding, Wuhan 430023, China
| | - Yinsheng Qiu
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan 430023, China
| | - Ling Guo
- Laboratory of Genetic Breeding, Reproduction and Precision Livestock Farming, School of Animal Science and Nutritional Engineering, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan 430023, China
- Hubei Provincial Center of Technology Innovation for Domestic Animal Breeding, Wuhan 430023, China
| | - Shulin Fu
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan 430023, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan 430023, China
| |
Collapse
|
2
|
Rosoph L, Ladel L, Patel R, Webster P. Intravenous Immunoglobulin-Induced Aseptic Meningitis in a Dermatomyositis Patient. Cureus 2024; 16:e58242. [PMID: 38745808 PMCID: PMC11093182 DOI: 10.7759/cureus.58242] [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: 04/10/2024] [Indexed: 05/16/2024] Open
Abstract
Aseptic meningitis is a rare but serious complication of treatment with intravenous immunoglobulin (IVIG) and often mimics meningitis of infectious etiology which poses a challenge for timely diagnosis. Although there are published recommendations on the management of IVIG-induced complications, there are no clear guidelines on the continuation of IVIG use after resolution of aseptic meningitis. We present a case of IVIG-induced aseptic meningitis in a patient with a history of refractory dermatomyositis who had been treated with immunosuppressive therapy and IVIG infusions for over a year. The patient developed intense head and neck pain with associated photophobia 24 hours after the most recent IVIG infusion. The patient was managed with supportive care consisting of intravenous fluids and analgesics. The patient's aseptic meningitis resolved without neurological complications. Ultimately, the patient was restarted on IVIG due to the recurrence of weakness from dermatomyositis. The patient tolerated re-initiation of IVIG without recurrence of IVIG-induced complications. This case highlights the importance of considering IVIG-induced aseptic meningitis as a differential diagnosis in evaluating patients with non-infectious meningitis even after regular IVIG infusions. This case also demonstrates that it is safe to reinitiate IVIG after the resolution of IVIG-induced aseptic meningitis.
Collapse
Affiliation(s)
- Leah Rosoph
- Internal Medicine, Yale University School of Medicine, Internal Medicine Residency Program at Norwalk Hospital, Norwalk, USA
| | - Luisa Ladel
- Internal Medicine, Yale University School of Medicine, Internal Medicine Residency Program at Norwalk Hospital, Norwalk, USA
| | - Ronak Patel
- Internal Medicine, Yale University School of Medicine, Internal Medicine Residency Program at Norwalk Hospital, Norwalk, USA
| | | |
Collapse
|
3
|
Li X, Sun S, Zhang H. RNA sequencing reveals differential long noncoding RNA expression profiles in bacterial and viral meningitis in children. BMC Med Genomics 2024; 17:50. [PMID: 38347610 PMCID: PMC10863080 DOI: 10.1186/s12920-024-01820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND We aimed to investigate the involvement of long non-coding RNA (lncRNA) in bacterial and viral meningitis in children. METHODS The peripheral blood of five bacterial meningitis patients, five viral meningitis samples, and five healthy individuals were collected for RNA sequencing. Then, the differentially expressed lncRNA and mRNA were detected in bacterial meningitis vs. controls, viral meningitis vs. healthy samples, and bacterial vs. viral meningitis patients. Besides, co-expression and the competing endogenous RNA (ceRNA) networks were constructed. Receiver operating characteristic curve (ROC) analysis was performed. RESULTS Compared with the control group, 2 lncRNAs and 32 mRNAs were identified in bacterial meningitis patients, and 115 lncRNAs and 54 mRNAs were detected in viral meningitis. Compared with bacterial meningitis, 165 lncRNAs and 765 mRNAs were identified in viral meningitis. 2 lncRNAs and 31 mRNAs were specific to bacterial meningitis, and 115 lncRNAs and 53 mRNAs were specific to viral meningitis. The function enrichment results indicated that these mRNAs were involved in innate immune response, inflammatory response, and immune system process. A total of 8 and 1401 co-expression relationships were respectively found in bacterial and viral meningitis groups. The ceRNA networks contained 1 lncRNA-mRNA pair and 4 miRNA-mRNA pairs in viral meningitis group. GPR68 and KIF5C, identified in bacterial meningitis co-expression analysis, had an area under the curve (AUC) of 1.00, while the AUC of OR52K2 and CCR5 is 0.883 and 0.698, respectively. CONCLUSIONS Our research is the first to profile the lncRNAs in bacterial and viral meningitis in children and may provide new insight into understanding meningitis regulatory mechanisms.
Collapse
Affiliation(s)
- Xin Li
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, No. 215 West Heping Street, Shijiazhuang, Hebei, 050000, China
- First Department of Neurology, Hebei Children's Hospital, Hebei Children's Hospital Affiliated to Hebei Medical University, Shijiazhuang, 050000, China
| | - Suzhen Sun
- First Department of Neurology, Hebei Children's Hospital, Hebei Children's Hospital Affiliated to Hebei Medical University, Shijiazhuang, 050000, China
| | - Huifeng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Hebei Medical University, No. 215 West Heping Street, Shijiazhuang, Hebei, 050000, China.
- First Department of Neurology, Hebei Children's Hospital, Hebei Children's Hospital Affiliated to Hebei Medical University, Shijiazhuang, 050000, China.
| |
Collapse
|
4
|
Oduoye MO, Akanbi-Hakeem HB, Muzammil MA, Arama UO, Abbasi HQ, Farhan K, Fariha FNU, Modupeoluwa OO, Paul HW, Badarou ADE, Akilimali A. Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations. Ann Med Surg (Lond) 2024; 86:345-352. [PMID: 38222679 PMCID: PMC10783331 DOI: 10.1097/ms9.0000000000001511] [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: 05/29/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Amidst coronavirus disease 2019 (COVID-19), there has been a misplaced priority on meningitis in the Niger Republic, thus refocusing resources and attention away from the continuing meningitis campaign in the Niger Republic. The over-strained state of public health resources and staff has also led to decreased surveillance, postponed diagnoses, and constrained immunization efforts in Niger Republic. This review aims to bridge the gaps regarding meningitis amid COVID-19 in Niger Republic and offer recommendations to government to mitigate meningitis in the country, with the hope of finding a permanent solution to this debilitating disease. The authors reviewed 45 past and present pieces of literature on meningitis and COVID-19 from 2013 to 2023 in well-renowned scientific databases such as PubMed, ResearchGate, Google Scholar, African Journals Online, Medline, and Embase. Since 2015, Niger Republic has experienced multiple meningitis epidemics that have resulted in 20, 789 cases and 1, 369 deaths [a case fatality rate (CFR) of 6.6%]. A total of 231 cases of meningitis were reported from 1 November 2021 to 31 January 2022. And recently, 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), occurred in the Zinder region, southeast of Niger Republic, from 1 November 2022 to 27 January 2023. Meningitis remains a public health concern in the world, especially in Niger Republic, which could lead to serious long-term complications. Therefore, adequate and novel measures and therapeutic actions should be implemented by the Niger Government to lessen the burden of the disease in the country.
Collapse
Affiliation(s)
- Malik Olatunde Oduoye
- Ahmadu Bello University, Zaria, Kaduna State
- Department of Research, Medical Research Circle, Bukavu
| | | | | | | | | | - Kanza Farhan
- Medical College, Jinnah Sindh Medical University, Karachi
| | | | | | - Houessou W. Paul
- Faculty of Health Sciences of Andre Salifou Zinder University, Niger Republic
| | - Achiraf-deen E. Badarou
- Department of General Medicine, FSS-Cotonou, Association of Medical Students of Cotonou, Cotonou, Littoral, Benin
| | - Aymar Akilimali
- Department of Research, Medical Research Circle, Bukavu
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of Congo
| |
Collapse
|
5
|
Zhong X, Wang M, Meng Q, Jiang X, Guo Z, Zhang Y, Gao D. Meningitis caused by oral anaerobes detected using mNGS tool: a case report and review of literature. BMC Neurol 2023; 23:344. [PMID: 37775739 PMCID: PMC10542268 DOI: 10.1186/s12883-023-03307-2] [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: 03/13/2023] [Accepted: 06/25/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Bacterial meningitis is a central nervous system (CNS) infection disease of the meninges and brain parenchyma caused by the bacteria. Few cases of meningitis related to oral anaerobes have been reported in the literature. Here, we report a case of meningitis in a middle-aged woman, caused by oral anaerobes. CASE PRESENTATION A 58-year-old woman was admitted to hospital with fever, headache for 21 days and left limb weakness for 2 days. The blood cell counts (11.73 × 109/L), neutrophil counts (9.22 × 109/L) and high-sensitivity C-reactive protein levels (> 5.00 mg/L) were elevated. The brain computerized tomography (CT) scanning indicated the new right thalamus infarct. The brain cranial-enhanced magnetic resonance imaging (MRI) showed the right lateral paraventricular and right thalamic infarct, and abnormal signal in occipital horns of bilateral lateral ventricles were increased. In addition, the brain enhanced nuclear magnetic resonance (NMR) scanning suggested that meninges were thickened and enhanced at the base of the brain, with meningitis changes. The neck CT angiography (CTA) revealed arteriosclerotic changes. The metagenomic next-generation sequencing (mNGS) revealed Eubacterium brachy, Porphyromonas gingivalis, Fusobacterium nucleatum and Torque teno virus in her cerebrospinal fluid (CSF). The patient was diagnosed with purulent meningitis caused by infection of oral anaerobes, and treated with mannitol, ceftriaxone and vancomycin. Her symptoms alleviated. Subsequently, she was transferred to the infectious department and treated with ceftriaxone plus metronidazole (anti-anaerobes) and mannitol (reduce intracranial pressure). Her symptoms improved and currently received rehabilitation treatment. CONCLUSION We herein report a rare case involving meningitis caused by infection of oral anaerobes. The mNGS can accurately detect the pathogens of infectious diseases.
Collapse
Affiliation(s)
- Xiaoqing Zhong
- Department Internal Medicine, MengZhou Minsheng Hospital, Mengzhou City, 454750, Jiaozuo, Henan Province, P.R. China
| | - Miaomiao Wang
- Department of Neurology, Pingdingshan First People's Hospital, Weidong District, Pingdingshan, 467021, Henan Province, P.R. China
| | - Qingxia Meng
- Internal Medicine-Neurology Wuqiao people's Hospital, Wuqiao County, Cangzhou, 061800, Hebei Province, P.R. China
| | - Xuebin Jiang
- Intensive Care Unit, Beijing Renhe Hospital, Daxing District, Beijing, 102600, P.R. China
| | - Zhendong Guo
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Xinhua District, Cangzhou, 061000, P.R. China
| | - Yunzhou Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100032, P.R. China.
| | - Daiquan Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100032, P.R. China.
| |
Collapse
|
6
|
Hudson A, Bobo D, Rueda Prada L, Dumic I, Petcu E, Cardozo M, Shweta F. Mania: An atypical presentation of probable Streptococcus agalactiae meningoencephalitis. IDCases 2023; 33:e01817. [PMID: 37645541 PMCID: PMC10461114 DOI: 10.1016/j.idcr.2023.e01817] [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: 05/09/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 08/31/2023] Open
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a common pathogen in the neonatal period, causing meningitis and sepsis. In non-pregnant adults it is an unusual cause of meningitis. We report about an elderly female with several risk factors for invasive GBS infection who developed GBS meningoencephalitis one month after treatment for COVID-19 upper respiratory tract infection. The patient presented with mania, and the classic triad of headache, neck stiffness, and fever was absent which contributed to the delay in diagnosis. Following initiation of treatment with intravenous ceftriaxone she attained full recovery, and her behavior returned to baseline. This case illustrates an unusual presentation of an emerging infection and should alert clinicians about this presentation. By reporting this case we want to raise awareness about mania as a presenting feature of meningoencephalitis. This should lead to more timely diagnosis and better outcomes for future patients.
Collapse
Affiliation(s)
- Ann Hudson
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Daniel Bobo
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Emilia Petcu
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Milena Cardozo
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Fnu Shweta
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
| |
Collapse
|
7
|
Velnar T, Kocivnik N, Bosnjak R. Clinical infections in neurosurgical oncology: An overview. World J Clin Cases 2023; 11:3418-3433. [PMID: 37383906 PMCID: PMC10294202 DOI: 10.12998/wjcc.v11.i15.3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/05/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
Central nervous system (CNS) infections are urgent conditions with high morbidity and mortality. Bacteria, viruses, parasites or fungi can cause them. Intracranial infections after craniotomies are an important complication of treatment, especially in oncological patients that are already immunologically compromised due to the disease and treatment. The consequence of CNS infections in oncological patients includes longer treatment with antibiotics, additional surgical procedures, higher treatment costs and poorer treatment outcomes. Additionally, the management of primary pathology may be prolonged or postponed as a result of the active infection. By introducing new and improved protocols, tightening controls on their implementation, constantly educating the entire team involved in patient treatment and educating both patients and relatives, the incidence of infections can be reduced effectively.
Collapse
Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Alma Mater Europaea - ECM Maribor, Maribor 2000, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| |
Collapse
|
8
|
Lucasti C, Scott MM, Vallee EK, Kowalski J. Intradural Candida Albicans infection that presented as epidural abscess: A case report. Int J Surg Case Rep 2023; 107:108337. [PMID: 37210802 DOI: 10.1016/j.ijscr.2023.108337] [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: 04/15/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Intradural Candida Albicans infections are rare with limited number of reports on the pathological condition. Among these reports, patients with these infections had radiographic evidence supporting an intradural infection diagnosis. In this case, the patient displayed radiographic imaging suggestive of an epidural infection, but surgery revealed the infection to be intradural. This case exemplifies the importance of considering intradural infections in future cases of suspected epidural abscesses and highlights antibiotic management of intradural C. albicans infections. PRESENTATION OF CASE A incarcerated 26-year-old male presented with a rare Candida Albicans infection. He arrived at the hospital unable to walk, and radiographic imaging was consistent with a thoracic epidural abscess. Due to his severe neurologic deficit and spreading edema, surgical intervention was required and revealed no signs of epidural infection. Incision of the dura revealed a purulent material cultured as C. albicans. After six weeks, the intradural infection returned and the patient required another surgery. This operation helped prevent further motor function loss. DISCUSSION When patients present with a progressive neurologic deficit and radiographic evidence indicative of an epidural abscess, it is important for surgeons to be mindful of a possible intradural infection. If no abscess is found in the epidural space during surgery, opening the dura in patients with worsening neurologic symptoms must be considered to rule out an intradural infection. CONCLUSION Preoperative suspicion of an epidural abscess can differ from intraoperative diagnosis and looking intradural for an infection can prevent further motor loss.
Collapse
Affiliation(s)
- Christopher Lucasti
- UBMD Orthopaedics and Sports Medicine Doctors Buffalo, Buffalo, NY, United States of America
| | - Maxwell M Scott
- Jacobs School of Medicine and Biomedical Sciences Buffalo, NY, United States of America
| | - Emily K Vallee
- Jacobs School of Medicine and Biomedical Sciences Buffalo, NY, United States of America.
| | - Joseph Kowalski
- UBMD Orthopaedics and Sports Medicine Doctors Buffalo, Buffalo, NY, United States of America
| |
Collapse
|
9
|
Li H, Wen J, Zhou JL, Chen B, Wu XR. Subarachnoid hemorrhage following wasp stings: A case report. Am J Emerg Med 2023; 68:215.e3-215.e7. [PMID: 37024323 DOI: 10.1016/j.ajem.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Three days after being stung by wasps in a rural area, a 60-year-old man was admitted to the emergency department with headaches. The physical examination showed that the patient was conscious, had moderate pain, had four head and back stings with local edema and erythema around the wounds, and had a stiff neck. Brain computed tomography upon admission revealed no abnormalities. Following lumbar puncture, the patient was diagnosed with subarachnoid hemorrhage (SAH) induced by wasp stings. No obvious aneurysms were found by either computed tomography angiography or three-dimensional rotational angiography. He received symptomatic treatment including antiallergy medication (chlorpheniramine and intravenous hydrocortisone), nimodipine for possible vasospasm, fluid infusion, and mannitol for intracranial pressure reduction and was discharged on the 14th day. This case of wasp sting-induced SAH is being reported to improve doctors' diagnostic abilities when encountering patients with wasp stings. It is important for emergency physicians to be aware that patients stung by wasps may develop rare complications such as SAH. Hymenoptera-induced SAH is an example of such a case.
Collapse
|
10
|
Yerdessov S, Zhunussova A, Imanova A, Gusmanov A, Sakko Y, Zhakhina G, Mussina K, Syssoyev D, Alimbayev A, Abbay A, Sarria-Santamera A, Gaipov A. Epidemiological characteristics and climatic variability of viral meningitis in Kazakhstan, 2014-2019. Front Public Health 2023; 10:1041135. [PMID: 36684964 PMCID: PMC9845948 DOI: 10.3389/fpubh.2022.1041135] [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: 09/10/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background The comprehensive epidemiology and impact of climate on viral meningitis (VM) in Kazakhstan are unknown. We aimed to study the incidence, in-hospital mortality and influence of climatic indicators on VM from 2014 to 2019. Methods Nationwide electronic healthcare records were used to explore this study. ICD-10 codes of VM, demographics, and hospital outcomes were evaluated using descriptive statistics and survival analysis. Results During the 2014-2019 period, 10,251 patients with VM were admitted to the hospital. 51.35% of them were children, 57.85% were males, and 85.9% were from the urban population. Enteroviral meningitis was the main cause of VM in children. The incidence rate was 13 and 18 cases per 100,000 population in 2014 and 2019, respectively. Case fatality rate was higher in 2015 (2.3%) and 2017 (2.0%). The regression model showed 1°C increment in the daily average temperature might be associated with a 1.05-fold (95% CI 1.047-1.051) increase in the daily rate of VM cases, 1hPa increment in the average air pressure and 1% increment in the daily average humidity might contribute to a decrease in the daily rate of VM cases with IRRs of 0.997 (95% CI 0.995-0.998) and 0.982 (95% CI 0.981-0.983), respectively. In-hospital mortality was 35% higher in males compared to females. Patients residing in rural locations had a 2-fold higher risk of in-hospital death, compared to city residents. Elderly patients had a 14-fold higher risk of in-hospital mortality, compared to younger patients. Conclusion This is the first study in Kazakhstan investigating the epidemiology and impact of climate on VM using nationwide healthcare data. There was a tendency to decrease the incidence with outbreaks every 5 years, and mortality rates were higher for Russians and other ethnicities compared to Kazakhs, for males compared to females, for elder patients compared to younger patients, and for patients living in rural areas compared to city residents. The climatic parameters and the days of delay indicated a moderate interaction with the VM cases.
Collapse
Affiliation(s)
- Sauran Yerdessov
- Department of Science and Education, CF “University Medical Center”, Astana, Kazakhstan,Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Assel Zhunussova
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Aliya Imanova
- Stroke Center, City Multidisciplinary Hospital No. 2, Astana, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Yesbolat Sakko
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Gulnur Zhakhina
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Kamilla Mussina
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Dmitriy Syssoyev
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Aidar Alimbayev
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Anara Abbay
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | | | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan,Clinical Academic Department of Internal Medicine, CF “University Medical Center”, Astana, Kazakhstan,*Correspondence: Abduzhappar Gaipov ✉
| |
Collapse
|
11
|
Huang N, Jia H, Zhou B, Zhou C, Cao J, Liao W, Liu S, Wang L, Chen L, Chen L, Zhou T, Ye J. Hypervirulent carbapenem-resistant Klebsiella pneumoniae causing highly fatal meningitis in southeastern China. Front Public Health 2022; 10:991306. [PMID: 36324461 PMCID: PMC9621088 DOI: 10.3389/fpubh.2022.991306] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 01/26/2023] Open
Abstract
Klebsiella pneumoniae (K. pneumoniae) is one of the most common causes of bacterial meningitis worldwide. The purpose of this study was to investigate the clinical and microbiological characteristics of K. pneumoniae meningitis, as well as the association of antimicrobial resistance, virulence, and patient prognosis. The clinical data of patients with K. pneumoniae meningitis from 2014 to 2020 in a tertiary teaching hospital were retrospectively evaluated. Antimicrobial susceptibility profiles were performed by the agar dilution method and broth microdilution method. The isolates were detected for virulence-related genes, resistance genes, capsular serotypes, and molecular subtypes. A total of 36 individuals with K. pneumoniae meningitis were included in the study, accounting for 11.3% (36/318) of all cases of bacterial meningitis. Of the 36 available isolates, K1, K47, and K64 were tied for the most frequent serotype (7/36, 19.4%). MLST analysis classified the isolates into 14 distinct STs, with ST11 being the most common (14/36, 38.9%). Carbapenem resistance was found in 44.4% (16/36) of the isolates, while hypervirulent K. pneumoniae (HvKP) was found in 66.7% (24/36) of the isolates. The isolates of hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP) were then confirmed to be 36.1% (13/36). Importantly, individuals with meningitis caused by Hv-CRKP had a statistically significant higher mortality than the other patients (92.3%, 12/13 vs. 56.5%, 13/23; P < 0.05). The high percentage and fatality of K. pneumoniae-caused meningitis, particularly in Hv-CRKP strains, should be of significant concern. More effective surveillance and treatment solutions will be required in future to avoid the spread of these life-threatening infections over the world.
Collapse
Affiliation(s)
- Na Huang
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huaiyu Jia
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beibei Zhou
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cui Zhou
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianming Cao
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
| | - Wenli Liao
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shixing Liu
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingbo Wang
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liqiong Chen
- School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China
| | - Lijiang Chen
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tieli Zhou
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Tieli Zhou
| | - Jianzhong Ye
- Department of Clinical Laboratory, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,*Correspondence: Jianzhong Ye
| |
Collapse
|
12
|
Pasteurella multocida as a Rare Cause of Neonatal Meningitis Complicated by Empyema. Pediatr Infect Dis J 2022; 41:e438-e440. [PMID: 35895885 DOI: 10.1097/inf.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A neonatal male injured by the family dog developed meningitis secondary to Pasteurella multocida . After initially defervescing with IV antibiotic treatment, he became febrile again, and imaging revealed a skull fracture and fluid collection. Following neurosurgical evacuation and an extended course of antibiotics, the patient was discharged home.
Collapse
|
13
|
Gofrit SG, Pikkel YY, Levine H, Fraifeld S, Kahana Merhavi S, Friedensohn L, Eliahou R, Ben-Hur T, Honig A. Characterization of Meningitis and Meningoencephalitis in the Israeli Defense Forces From 2004 to 2015: A Population-Based Study. Front Neurol 2022; 13:887677. [PMID: 35847223 PMCID: PMC9279563 DOI: 10.3389/fneur.2022.887677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Meningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers. Methods Medical charts of 860,000 combat and non-combat soldiers serving during the years 2004–2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected. Results Approximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); p = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); p = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); p = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); p < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); p < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); p < 0.001]. N. meningitidis was the most frequently isolated bacteria, despite universal preventative vaccination. Conclusion The incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.
Collapse
Affiliation(s)
| | - Yoav Yechezkel Pikkel
- Medical Corps of the Israel Defense Forces, Haifa, Israel
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Shifra Fraifeld
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Limor Friedensohn
- Medical Corps of the Israel Defense Forces, Haifa, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Ruth Eliahou
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Tamir Ben-Hur
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Asaf Honig
- Medical Corps of the Israel Defense Forces, Haifa, Israel
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
- *Correspondence: Asaf Honig
| |
Collapse
|
14
|
Serum Neurogranin Measurement as a Biomarker of Central Nervous System Infections: A Preliminary Study. Keio J Med 2022; 71:62-67. [PMID: 35718469 DOI: 10.2302/kjm.2021-0019-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The early diagnosis of central nervous system infections is of great importance to minimize morbidity and mortality. Neurogranin is a postsynaptic neural protein, and when the blood-brain barrier is damaged, neurogranin levels increase in both the cerebrospinal fluid and serum. The aim of this study was to evaluate the level of serum neurogranin and to investigate its utility in the diagnosis of central nervous system infections. This study was conducted as a prospective case-control study of patients diagnosed with meningitis. The study initially included 55 patients, and 15 patients with proven central nervous system infection were ultimately included in the patient group. The results in the patient group were compared with those of the control group of 15 healthy subjects. The 15 patients comprised 4 women and 11 men with a mean cerebrospinal fluid neurogranin level of 432.4 ± 123.5 ng/ml. Correlation analysis revealed a moderate positive correlation between cerebrospinal fluid neurogranin levels and serum neurogranin levels. The mean serum neurogranin level was 198.6 ± 51.7 ng/ml in the control group but was significantly higher at 429.2 ± 104.3 ng/ml in the patient group. In conclusion, it may be useful to measure blood neurogranin levels in patients suspected of having central nervous system infections, especially in those for whom computed tomography, magnetic resonance imaging, or lumbar puncture cannot be performed.
Collapse
|
15
|
Guo L, Cheng H, Fu S, Liu J, Zhang Y, Qiu Y, Chen H. Methylome and Transcriptome-Based Integration Analysis Identified Molecular Signatures Associated With Meningitis Induced by Glaesserella parasuis. Front Immunol 2022; 13:840399. [PMID: 35281072 PMCID: PMC8913945 DOI: 10.3389/fimmu.2022.840399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Glaesserella parasuis (G. parasuis) can elicit serious inflammatory responses and cause meningitis in piglets. Previous epigenetic studies have indicated that alterations in host DNA methylation may modify the inflammatory response to bacterial infection. However, to date, genome-wide analysis of the DNA methylome during meningitis caused by G. parasuis infection is still lacking. In this study, we employed an unbiased approach using deep sequencing to profile the DNA methylome and transcriptome from G. parasuis infected porcine brain (cerebrum) and integrated the data to identify key differential methylation regions/sites involved in the regulation of the inflammatory response. Results showed that DNA methylation patterns and gene expression profiles from porcine brain were changed after G. parasuis infection. The majority of the altered DNA methylation regions were found in the intergenic regions and introns and not associated with CpG islands, with only a low percentage occurring at promoter or exon regions. Integrated analysis of the DNA methylome and transcriptome identified a number of inversely and positively correlated genes between DNA methylation and gene expression, following the criteria of |log2FC| > 0.5, |diffMethy| > 0.1, and P < 0.05. Differential expression and methylation of two significant genes, semaphoring 4D (SEMA4D) and von Willebrand factor A domain containing 1 (VWA1), were validated by qRT-PCR and bisulfite sequencing. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses demonstrated that DNA methylation inversely correlated genes in G. parasuis infected porcine brains were mainly involved with cell adhesion molecules (CAMs), bacterial invasion of epithelial cells, RIG-1-like receptor signaling pathways, and hematopoietic cell lineage signaling pathways. In addition, a protein-protein interaction network of differentially methylated genes found potential candidate molecular interactions relevant to the pathology of G. parasuis infection. To the best of our knowledge, this is the first attempt to integrate the DNA methylome and transcriptome data from G. parasuis infected porcine brains. Our findings will help understanding the contribution of genome-wide DNA methylation to the pathogenesis of meningitis in pigs and developing epigenetic biomarkers and therapeutic targets for the treatment of G. parasuis induced meningitis.
Collapse
Affiliation(s)
- Ling Guo
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| | - Hongxing Cheng
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| | - Shulin Fu
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| | - Jun Liu
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| | - Yunfei Zhang
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| | - Yinsheng Qiu
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
- *Correspondence: Yinsheng Qiu,
| | - Hongbo Chen
- Hubei Key Laboratory of Animal Nutrition and Feed Science, Wuhan Polytechnic University, Wuhan, China
- Hubei Collaborative Innovation Center for Animal Nutrition and Feed Safety, Wuhan Polytechnic University, Wuhan, China
| |
Collapse
|
16
|
D'Aleo F, Bonanno R, Bonofiglio M. New methods in meningitis diagnosis. MICROBIOLOGIA MEDICA 2021. [DOI: 10.4081/mm.2021.10235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Meningitis remains a worldwide problem and Central nervous system (CNS) infections are associated with devastating sequelae, including cognitive deficits, vision and hearing impairment, motor and sensory deficits and epilepsy in over one-half of survivors. Rapid diagnosis of meningitis is essential to improve chances at survival and minimize unnecessary healthcare costs related to isolation procedures and empiric treatment. Multiplex molecular assays are an attractive option for the simultaneous detection of several microbial targets. Currently, several assays are marketed. The aim of our review is to comprehensively evaluate the molecular available systems of using a new multiplex PCR panel in determining the microbiologic etiologies of meningitis.
Collapse
|
17
|
Vimentin Regulates Chemokine Expression and NOD2 Activation in Brain Endothelium during Group B Streptococcal Infection. Infect Immun 2021; 89:e0034021. [PMID: 34491787 DOI: 10.1128/iai.00340-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, or GBS) is an opportunistic pathogen capable of causing invasive disease in susceptible individuals, including the newborn. Currently, GBS is the leading cause of meningitis in the neonatal period. We have recently shown that GBS interacts directly with host type III intermediate filament vimentin to gain access to the central nervous system. This results in characteristic meningeal inflammation and disease progression; however, the specific role of vimentin in the inflammatory process is unknown. Here, we investigate the contribution of vimentin to the pathogenesis of GBS meningitis. We show that a CRISPR-targeted deletion of vimentin in human cerebral microvascular endothelial cells (hCMEC) reduced GBS induction of neutrophil attractants interleukin-8 (IL-8) and CXCL-1 as well as NF-κB activation. We further show that inhibition of vimentin localization also prevented similar chemokine activation by GBS. One known chemokine regulator is the nucleotide-binding oligomerization domain containing protein 2 (NOD2), which is known to interact directly with vimentin. Thus, we hypothesized that NOD2 would also promote GBS chemokine induction. We show that GBS infection induced NOD2 transcription in hCMEC comparably to the muramyl dipeptide (MDP) NOD2 agonist, and the chemokine induction was reduced in the presence of a NOD2 inhibitor. Using a mouse model of GBS meningitis, we also observed increased NOD2 transcript and NOD2 activation in brain tissue of infected mice. Lastly, we show that NOD2-mediated IL-8 and CXCL1 induction required vimentin, further indicating the importance of vimentin in mediating inflammatory responses in brain endothelium.
Collapse
|
18
|
Wang J, Meng M, Xu H, Wang T, Liu Y, Yan H, Liu P, Qin D, Yang Q. Analysis of enterovirus genotypes in the cerebrospinal fluid of children associated with aseptic meningitis in Liaocheng, China, from 2018 to 2019. BMC Infect Dis 2021; 21:405. [PMID: 33933008 PMCID: PMC8088645 DOI: 10.1186/s12879-021-06112-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aseptic meningitis is most often caused by enteroviruses (EVs), but EVs associated with aseptic meningitis have not yet been reported in Liaocheng. The aim of this study was to determine the prevalence and genetic characteristics of EVs causing aseptic meningitis in children in Liaocheng. METHODS We reviewed the epidemiological and clinical characteristics of 504 paediatric cases of aseptic meningitis in Liaocheng from 2018 to 2019 and analysed the phylogeny of the predominant EV types causing this disease. RESULTS A total of 107 children were positive for EV in cerebrospinal fluid samples by nested PCR. Most of the positive patients were children 13 years old or younger and had symptoms such as fever, headache and vomiting (P < 0.05). The seasons with the highest prevalence of EV-positive cases were summer and autumn. The 107 EV sequences belonged to 8 serotypes, and echovirus types 18, 6 and 11 were the three dominant serotypes in Liaocheng during the 2-year study period. Phylogenetic analyses demonstrated that the E18 and E6 isolates belonged to subgenotype C2, while the E11 isolates belonged to subgenotype D5. VP1 analysis suggested that only one lineage of these three types was cocirculating in the Liaocheng region. CONCLUSIONS This study demonstrated the diverse EV genotypes contributing to a large outbreak of aseptic meningitis in Liaocheng. Therefore, large-scale surveillance is required to assess the epidemiology of EVs associated with aseptic meningitis and is important for the diagnosis and treatment of aseptic meningitis in Liaocheng.
Collapse
Affiliation(s)
- Jing Wang
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Min Meng
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Huan Xu
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Ting Wang
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China.
| | - Ying Liu
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Han Yan
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Peiman Liu
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Daogang Qin
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| | - Qiaozhi Yang
- Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, No. 67 Dongchang West Road, Liaocheng, 252000, Shandong Province, PR China
| |
Collapse
|
19
|
He Y, Zhang X, Sun Y, Gong P, Yu H. Promotion properties of TLR7 in pediatric meningitis via the NF-κB pathway. J Bioenerg Biomembr 2021; 53:39-48. [PMID: 33428046 DOI: 10.1007/s10863-020-09862-4] [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: 07/05/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Meningitis outcome is associated with the severity of inflammation in the subarachnoid space and that the outcome can be improved through anti-inflammation. However, a comprehensive understanding of the molecular basis underlying inflammatory responses in meningitis remains enigmatic. In the current study, we sought to determine the molecular mechanism of TLR7/NF-κB on the development of meningitis in children. Cerebrospinal fluid of patients with meningitis and children with simple febrile convulsions was collected, and meningitis mouse model was induced. TLR7 expression was determined in the serum of meningitis model mice and the cerebrospinal fluid of patients using RT-qPCR and Western blot. Afterwards, loss- and gain- function assays were conducted to determine the functional role of TLR7 in meningitis mouse model. The level of procalcitonin (PCT) and the number of bacterial colonies in the serum were analyzed. ELISA was used to detect the expression of inflammatory factors. Upregulated level of TLR7 was observed in patients and mice with meningitis. Inhibiting the expression of TLR7 inhibited the development of meningitis. Overexpressing TLR7 can activate the NF-κB signaling pathway and promote mouse meningitis. NF-κB signaling pathway inhibitor reversed promotion of meningitis caused by TLR7 activation. Our study provides evidence that TLR7 elevation can activate the NF-κB signaling pathway and promote meningitis in mice.
Collapse
Affiliation(s)
- Yiwei He
- Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, 410005, People's Republic of China
| | - Xianhua Zhang
- Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, 410005, People's Republic of China
| | - Ying Sun
- Department of Neurology, Kunming Children's Hospital, No. 288, Qianxing Road, Xishan District, Kunming, 650000, Yunnan Province, People's Republic of China.
| | - Ping Gong
- Department of Pediatrics, Hunan Provincial People's Hospital, Changsha, 410005, People's Republic of China
| | - Hong Yu
- Department of Pathology, The Third People's Hospital of Shenzhen, Shenzhen, 518100, People's Republic of China
| |
Collapse
|
20
|
Nong Y, Liang Y, Liang X, Li Y, Yang B. Pharmacological targets and mechanisms of calycosin against meningitis. Aging (Albany NY) 2020; 12:19468-19492. [PMID: 33031061 PMCID: PMC7732281 DOI: 10.18632/aging.103886] [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: 06/02/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023]
Abstract
This report aimed to identity the potential anti-meningitis targets and mechanisms functioned by calycosin through network pharmacology approach. The bioinformatics databases were used to screen and collect the candidate genes/targets of calycosin and meningitis prior to identification of vital biotargets of calycosin-anti-meningitis. Additionally, the functional processes, signaling pathways of calycosin-anti-meningitis were screened and identified before further data visualization. As a result, all candidate and mapped biotargets of calycosin and meningitis were harvested before the vital targets of epidermal growth factor receptor (EGFR), tumor necrosis factor (TNF), epidermal growth factor (EGF), ataxia telangiectasia mutated protein (ATM), estrogen receptor alpha (ESR1), caspase-8 (CASP8), nerve growth factor (NGF) of calycosin-anti-meningitis were identified. The molecular processes of calycosin-anti-meningitis were screened and identified, including reduction of inflammatory development. Furthermore, the molecular pathways of calycosin-anti-meningitis were revealed, including suppression of NF-kappa B, Toll-like receptor, TNF signaling pathways. Molecular docking findings uncovered the docking capacity of calycosin with meningitis and potential pharmacological activity of calycosin against meningitis. In conclusion, these bioinformatic data uncovered the network targets and mechanisms of calycosin-anti-meningitis. And the current findings indicated that the vital targets might be used as potent biomarkers for detecting meningitis.
Collapse
Affiliation(s)
- Yuan Nong
- Department of Neurology (Area Two), Guigang City People’s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, PR China
| | - Yujia Liang
- College of Pharmacy, Guangxi Medical University, Nanning, Guangxi, PR China
| | - Xiaoliu Liang
- Department of Neurology (Area Two), Guigang City People’s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, PR China
| | - Yongming Li
- Department of Gynecology, Guigang City People's Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, PR China
| | - Bin Yang
- Department of Neurology (Area Two), Guigang City People’s Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, PR China
| |
Collapse
|
21
|
Ng MMY, D'Arco F, Chorbachi R, Nash R. Oval window perilymph fistula in child with recurrent meningitis and unilateral hearing loss. BMJ Case Rep 2020; 13:13/7/e234744. [PMID: 32713834 DOI: 10.1136/bcr-2020-234744] [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
A 2-year-old boy presented to Ears, Nose and Throat (ENT) surgeons with unilateral hearing loss. Following a prodrome of upper respiratory tract infection (URTI), he developed two episodes of pneumococcal meningitis in quick succession. This case demonstrates an unusual cause of perilymph fistula diagnosed on imaging and confirmed surgically. He had failed the Newborn Hearing Screening Programme and was therefore referred to audiology, who confirmed profound sensorineural hearing loss in the right ear. MRI showed incomplete partitioning (type 1) of the right cochlea, suggesting cerebrospinal fluid (CSF) leak from the region of the stapes. Exploratory tympanotomy confirmed this, and proceeded to CSF leak repair, obliteration of the Eustachian tube, subtotal petrosectomy, abdominal fat grafting and blind sac closure. Although middle ear effusions are common; particularly in children with recent URTI, the possibility of otogenic CSF leak needs to be considered, especially in cases of recurrent meningitis.
Collapse
Affiliation(s)
- Miane Min Yan Ng
- Ear, Nose and Throat Surgery Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Felice D'Arco
- Department of Radiology, NIHR GOSH BRC, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Raouf Chorbachi
- Department of Audiological Medicine/Audiology/Cochlear Implants, North Thames Cleft Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Robert Nash
- Department of Paediatric Otolaryngology, Cochlear Implants, Great Ormond Street Hospital for Children NHS Trust, London, UK.,University College London, London, UK
| |
Collapse
|
22
|
Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections. Antibiotics (Basel) 2020; 9:antibiotics9060282. [PMID: 32466378 PMCID: PMC7344633 DOI: 10.3390/antibiotics9060282] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/03/2022] Open
Abstract
Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt diagnostic evaluation and correct antimicrobial treatment. A retrospective, multicenter, pre/post intervention study was performed to evaluate the impact that the BioFire® FilmArray® meningitis/encephalitis (ME) panel run in-house had on the clinical management of adult patients admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was the effect that this intervention had on herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT). Secondary outcomes included the effect that this intervention had on antiviral days of therapy (DOT), total antimicrobial DOT, and hospital length of stay (LOS). A total of 81 and 79 patients were included in the pre-intervention and post-intervention cohorts, respectively. The median HSV PCR TAT was significantly longer in the pre-intervention group (85 vs. 4.1 h, p < 0.001). Total antiviral DOT was significantly greater in the pre-intervention group (3 vs. 1, p < 0.001), as was total antimicrobial DOT (7 vs. 5, p < 0.001). Pre-intervention hospital LOS was also significantly longer (6.6 vs. 4.4 days, p = 0.02). Implementing the ME panel in-house for adults undergoing an LP for a suspected community-onset CNS infection significantly reduced the HSV PCR TAT, antiviral DOT, total antimicrobial DOT, and hospital LOS.
Collapse
|
23
|
De Almeida SM, Barros NC, Petterle R, Nogueira K. Comparison of cerebrospinal fluid lactate with physical, cytological, and other biochemical characteristics as prognostic factors in acute bacterial meningitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:871-880. [PMID: 31939584 DOI: 10.1590/0004-282x20190185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Bacterial meningitis (BM) is associated with a high morbidity and mortality. Cerebrospinal fluid (CSF) lactate may be used as a prognostic marker of this condition. We hypothesized that CSF lactate levels would remain elevated in participants who died of acute BM compared with those who recovered from this disease. To evaluate the potential use of lactate and other CSF biomarkers as prognostic markers of acute BM outcome. METHODS This retrospective, longitudinal study evaluated dynamic CSF biomarkers in 223 CSF samples from 49 patients who fulfilled the inclusion criteria of acute BM, with bacteria identified by CSF culturing. The participants were grouped according to outcome: death (n = 9; 18.37%) and survival (n = 40; 81.63%). All participants received appropriate antibiotic treatment. RESULTS In the logistic regression model, lactate concentration in the final CSF sample, xanthochromia, and CSF glucose variation between the first and last CSF samples were predictors of a poor outcome (death). In contrast, decrease in CSF white blood cell count and CSF percentage of neutrophils, increase in the percentage of lymphocytes, and normalization of the CSF lactate concentration in the last CSF sample were predictors of a good prognosis. CONCLUSION The study confirmed the initial hypothesis. The longitudinal analysis of CSF lactate is an important predictor of prognosis in acute BM.
Collapse
Affiliation(s)
| | - Nagyla C Barros
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
| | - Ricardo Petterle
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
| | - Keite Nogueira
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
| |
Collapse
|
24
|
Grommen B, Öztürk GZ. A Case Report: Aseptic Meningitis. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Meningitis is an inflammation of the leptomeninges which surround the brain and the spinal cord. Depending on the organism, it is categorized as aseptic or bacterial meningitis. Cerebro-spinal fluid analyse and its culture are used for this categorization. Although it is thought to occur more frequent in paediatric population, 7.6 out of 100000 adults are affected by the disease. Some people may have sequels such as cognitive impairment, focal neurologic deficits and hearing loss. The mortality of viral meningitis is 4.5%, while it is 14.8% with bacterial meningitis. Headache, nausea and vomiting are the most seen complaints in the early stages of the disease. Because of that it can primarily be misdiagnosed with upper respiratory tract infections but also with other diseases. Therefore, some people may have a late diagnose. That increases the morbidity and the mortality.
This case report, describes a patient who was diagnosed with aseptic meningitis. The patient presented herself to our clinic with the complaints of headache, intermittent fever, stomach ache, and voiding difficulty.
Keywords: aseptic meningitis, Family Practice, vaccination
Collapse
Affiliation(s)
- Berksu Grommen
- Department of Family Medicine, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Güzin Zeren Öztürk
- Department of Family Medicine, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul
| |
Collapse
|
25
|
Berangi Z, Karami M, Mohammadi Y, Nazarzadeh M, Zahraei SM, Javidrad H, Heidari S. Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction. BMC Pediatr 2019; 19:370. [PMID: 31640619 PMCID: PMC6806508 DOI: 10.1186/s12887-019-1741-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No reliable and comprehensive study has been published on the incidence and epidemiological profile of meningitis in Iran from 2008 to 2014, before pneumococcal conjugate vaccine (PCV) and pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed)) introduction. The present study aimed to portray the epidemiological profile of meningitis in Iran from 2008 to 2014. METHODS Data on meningitis cases aged from 1 day to 110 years were extracted from national notifiable diseases surveillance system from March 2008 to December 2014 in Iran. A total number of 48,006 cases of suspected meningitis were identified and 1468 cases of which met the criteria for diagnosis-confirmed meningitis. Of 1468 cases, 1352 patients were included in the study. RESULTS The great number of cases reported from urban areas. Moreover, males were more predominant than females (58.51% vs. 33.81%) in total. The estimated annual incidence rate of meningitis varied from 0.28/100000 in 2008 to 0.09/100000 in 2014. Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis were the most leading pathogens causing bacterial meningitis, accounted for 266(23.44%), 145(12.78%), 95(8.37%) of cases, respectively. Each of the three bacterial species showed a descending trend. The majority of infected subjects are children under five years. CONCLUSIONS Unlike the decreasing trend of meningitis and high percentage of cultures with negative results, according to World Health Organization recommendation PCV introduction into routine immunization is evident. Implementing an enhanced surveillance system to provide high quality data on epidemiological profile of meningitis in Iran is necessary.
Collapse
Affiliation(s)
- Zeinab Berangi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran. .,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Younes Mohammadi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Milad Nazarzadeh
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Hamidreza Javidrad
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Saber Heidari
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
| |
Collapse
|
26
|
Mao DH, Miao JK, Zou X, Chen N, Yu LC, Lai X, Qiao MY, Chen QX. Risk Factors in Predicting Prognosis of Neonatal Bacterial Meningitis-A Systematic Review. Front Neurol 2018; 9:929. [PMID: 30515129 PMCID: PMC6255960 DOI: 10.3389/fneur.2018.00929] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/12/2018] [Indexed: 02/03/2023] Open
Abstract
Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis. Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis. Studies published from the initiation of the database to April 30th, 2017 were included. The quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). The quality of cross-section studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) scale. Each prognostic factor known to cause adverse outcomes is summarized. Results: Sixteen studies were identified, including 7 cohort studies and 9 cross section studies. Seizure and high protein levels in the cerebrospinal fluid (CSF) predict a poor prognosis in this disease. Coma, the need for ventilation support, and leukopenia also had some value for predicting poor prognoses. A bulging anterior fontanelle was valuable for predicting mortality. Low CSF glucose levels, thrombocytopenia, gestational age (GA) < 37 weeks and an altered sensorium were correlated with a poor prognosis. A birth weight < 2500 g, early onset meningitis and positive CSF cultures were correlated with mortality. Conclusions: This study provides a preliminary exploration of prognostic factors in neonatal bacterial meningitis and thereby fills some of the gaps in the study of prognoses in this disease. These prognostic factors can be used to predict and estimate outcomes in neonatal bacterial meningitis. Without a meta-analysis, the reliability of these factors cannot be assured. In addition, these results emphasize that there is an urgent need for a standardized protocol for follow-up and well-designed prognostic studies in neonatal bacterial meningitis.
Collapse
Affiliation(s)
- Dan-Hua Mao
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Jing-Kun Miao
- Chongqing International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
| | - Xian Zou
- Chongqing International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
| | - Na Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lin-Chao Yu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xin Lai
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Meng-Yuan Qiao
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi-Xiong Chen
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| |
Collapse
|
27
|
Lee JW, Park CI, Kim HI, Kim OH, Cha KC, Kim H, Lee KH, Hwang SO, Cha YS. The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department. Clin Exp Emerg Med 2016; 3:95-99. [PMID: 27752624 PMCID: PMC5051609 DOI: 10.15441/ceem.15.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/10/2016] [Accepted: 04/14/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE When managing patients with acute meningitis in an emergency department (ED), early diagnosis of the type of infection (bacterial or viral) considerably affects the clinical course and treatment because of the high mortality and morbidity associated with bacterial meningitis (BM). The serum delta neutrophil index (DNI), a new inflammatory marker, reflects the fraction of circulating immature granulocytes and is elevated in cases of bacterial infection. The objective of this study was to evaluate whether serum DNI can be used to differentiate between BM and viral meningitis (VM) in the ED. METHODS This retrospective, observational study included 104 consecutive patients (aged >18 years) diagnosed with acute meningitis from January 2012 to November 2014 in a regional emergency center. White blood cell and neutrophil counts, C-reactive protein level, and DNI were evaluated regarding their usefulness for differentiating BM and VM. RESULTS Serum DNI was not significantly higher in the BM group (n=12) than in the VM group (n=92) (0 [interquartile range, 0% to 2.73%] vs. 0 [interquartile range, 0 to 0%], P=0.057). However, the white blood cell count and C-reactive protein level were statistically higher in the BM group (P=0.034 and P=0.026, respectively). Serum DNI was not found to be a statistically useful differential diagnostic parameter (area under the curve, 0.628; 95% confidence interval, 0.438 to 0.818). CONCLUSION Currently, there is no evidence that the serum DNI aids in differentiating acute BM from acute VM in the ED.
Collapse
Affiliation(s)
- Joon Woo Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chan Ik Park
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyung Il Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Oh Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kang Hyun Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
28
|
Wang S, Peng L, Gai Z, Zhang L, Jong A, Cao H, Huang SH. Pathogenic Triad in Bacterial Meningitis: Pathogen Invasion, NF-κB Activation, and Leukocyte Transmigration that Occur at the Blood-Brain Barrier. Front Microbiol 2016; 7:148. [PMID: 26925035 PMCID: PMC4760054 DOI: 10.3389/fmicb.2016.00148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
Bacterial meningitis remains the leading cause of disabilities worldwide. This life-threatening disease has a high mortality rate despite the availability of antibiotics and improved critical care. The interactions between bacterial surface components and host defense systems that initiate bacterial meningitis have been studied in molecular and cellular detail over the past several decades. Bacterial meningitis commonly exhibits triad hallmark features (THFs): pathogen penetration, nuclear factor-kappaB (NF-κB) activation in coordination with type 1 interferon (IFN) signaling and leukocyte transmigration that occur at the blood-brain barrier (BBB), which consists mainly of brain microvascular endothelial cells (BMEC). This review outlines the progression of these early inter-correlated events contributing to the central nervous system (CNS) inflammation and injury during the pathogenesis of bacterial meningitis. A better understanding of these issues is not only imperative to elucidating the pathogenic mechanism of bacterial meningitis, but may also provide the in-depth insight into the development of novel therapeutic interventions against this disease.
Collapse
Affiliation(s)
- Shifu Wang
- Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong UniversityJinan, China; Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA, USA
| | - Liang Peng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Guangzhou Medical University Guangzhou, China
| | - Zhongtao Gai
- Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong University Jinan, China
| | - Lehai Zhang
- Department of Children's Medical Laboratory Diagnosis Center, Qilu Children's Hospital of Shandong University Jinan, China
| | - Ambrose Jong
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Hong Cao
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Microbiology, School of Public Health and Tropical Medicine, Southern Medical University Guangzhou, China
| | - Sheng-He Huang
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| |
Collapse
|
29
|
Bastos MS, Coelho-Dos-Reis JG, Zauli DAG, Naveca FG, Monte RL, Pimentel JP, Macário VMK, da Silva NL, Peruhype-Magalhães V, Pascoal-Xavier MA, Guimaraes A, Carvalho AT, Malheiro A, Martins-Filho OA, Mourão MPG. Divergent cerebrospinal fluid cytokine network induced by non-viral and different viral infections on the central nervous system. BMC Infect Dis 2015; 15:345. [PMID: 26286516 PMCID: PMC4541733 DOI: 10.1186/s12879-015-1035-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/16/2015] [Indexed: 11/23/2022] Open
Abstract
Background Meningoencephalitis is one of the most common disorders of the central nervous system (CNS) worldwide. Viral meningoencephalitis differs from bacterial meningitis in several aspects. In some developing countries, bacterial meningitis has appropriate clinical management and chemotherapy is available. Virus-associated and virus not detected meningoencephalitis are treatable, however, they may cause death in a few cases. The knowledge of how mediators of inflammation can induce disease would contribute for the design of affordable therapeutic strategies, as well as to the diagnosis of virus not detected and viral meningoencephalitis. Cytokine-induced inflammation to CNS requires several factors that are not fully understood yet. Methods Considering this, several cytokines were measured in the cerebrospinal fluid (CSF) of patients with undiagnosed and viral meningoencephalitis, and these were correlated with cellularity in the CSF. Results The results demonstrate that an altered biochemical profile alongside increased cellularity in the cerebrospinal fluid is a feature of patients with meningoencephalitis that are not associated with the detection of virus in the CNS (P < 0.05). Moreover, HIV-positive patients (n = 10) that evolve with meningoencephalitis display a distinct biochemical/cytological profile (P < 0.05) in the cerebrospinal fluid. Meningoencephalitis brings about a prominent intrathecal cytokine storm regardless of the detection of virus as presumable etiological agent. In the case of Enterovirus infection (n = 13), meningoencephalitis elicits robust intrathecal pro-inflammatory cytokine pattern and elevated cellularity when compared to herpesvirus (n = 15) and Arbovirus (n = 5) viral infections (P < 0.05). Conclusion Differences in the cytokine profile of the CSF may be unique if distinct, viral or presumably non-viral pathways initially trigger the inflammatory response in the CNS.
Collapse
Affiliation(s)
| | - Jordana Grazziela Coelho-Dos-Reis
- Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center, FIOCRUZ, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, Minas Gerais, CEP 30190-002, Brazil.
| | - Danielle Alves Gomes Zauli
- Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center, FIOCRUZ, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, Minas Gerais, CEP 30190-002, Brazil. .,Instituto Hermes Pardini, Belo Horizonte, MG, Brazil.
| | | | | | | | | | | | - Vanessa Peruhype-Magalhães
- Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center, FIOCRUZ, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, Minas Gerais, CEP 30190-002, Brazil.
| | | | - Allyson Guimaraes
- Hematology and Hemotherapic Foundation of Amazonas, Manaus, AM, Brazil.
| | - Andréa Teixeira Carvalho
- Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center, FIOCRUZ, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, Minas Gerais, CEP 30190-002, Brazil.
| | - Adriana Malheiro
- Hematology and Hemotherapic Foundation of Amazonas, Manaus, AM, Brazil.
| | - Olindo Assis Martins-Filho
- Laboratory of Biomarkers for Diagnosis and Monitoring, René Rachou Research Center, FIOCRUZ, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, Minas Gerais, CEP 30190-002, Brazil.
| | - Maria Paula Gomes Mourão
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, AM, Brazil. .,Amazonas State University, Manaus, AM, Brazil.
| |
Collapse
|