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Andrade HB, da Silva IRF, Espinoza R, Ferreira MT, da Silva MST, Theodoro PHN, Detepo PJT, Varela MC, Ramos GV, da Silva AR, Soares J, Belay ED, Sejvar JJ, Bozza FA, Cerbino-Neto J, Japiassú AM. Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area. J Crit Care 2024; 79:154451. [PMID: 37871403 DOI: 10.1016/j.jcrc.2023.154451] [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: 08/22/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates. MATERIALS AND METHODS We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality. RESULTS In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression. CONCLUSIONS Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.
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Affiliation(s)
- Hugo Boechat Andrade
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil; Sexually Transmitted Diseases Sector, Biomedical Institute, Federal Fluminense University (UFF), Niterói, RJ, Brazil.
| | | | - Rodolfo Espinoza
- Surgical Intensive Care Unit, Hospital Copa Star, Rio de Janeiro, RJ, Brazil; Intensive Care Unit II, Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | - Marcel Treptow Ferreira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Mayara Secco Torres da Silva
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Pedro Henrique Nascimento Theodoro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Paula João Tomás Detepo
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
| | - Margareth Catoia Varela
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil; Immunization and Health Surveillance Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Grazielle Viana Ramos
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Aline Reis da Silva
- Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Jesus Soares
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ermias D Belay
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Fernando Augusto Bozza
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil; Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - José Cerbino-Neto
- Immunization and Health Surveillance Research Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - André Miguel Japiassú
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil
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Mésinèle L, Pujol T, Brunetti N, Neiss M, Trivalle C, Souques C, Houenou-Quenum N, Verdier S, Simon P, Vetillard AL, Houdre J, Collarino R, Mary M, Vidal JS, Kahn JE, Guichardon M, Duron E, Baudouin E. Association between low eosinophil count and acute bacterial infection, a prospective study in hospitalized older adults. BMC Geriatr 2023; 23:852. [PMID: 38093181 PMCID: PMC10720062 DOI: 10.1186/s12877-023-04581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The incidence of sepsis increases significantly with age, including a high incidence of bacterial infection in the old adults. Eosinopenia and the CIBLE score have been proposed in critically ill adults and in internal medicine wards. This study aimed to assess whether a low eosinophil count was associated with acute bacterial infection among hospitalized older adults, and to find the most efficient eosinophil count cut-off to differentiate acute bacterial infection from other inflammatory states. METHODS This was a prospective study from July 2020 to July 2022 in geriatric wards of the University Paul Brousse Hospital (Villejuif, France) including patients aged of 75 y/o or over suffering from fever or biological inflammation. Acute bacterial infection was assessed using biological identification and/or clinical and radiological data. RESULTS A total of 156 patients were included. Eighty-two (53%) patients suffered from acute bacterial infection (mean age (SD) 88.7 (5.9)). Low eosinophil count was independently associated with acute bacterial infection: OR [CI95%] 3.03 [1.04-9.37] and 6.08 [2.42-16.5] for eosinophil count 0-0.07 G/L and 0.07-0.172 G/L respectively (vs. eosinophil count > 0.172 G/L). Specificity and sensitivity for eosinophil count < 0.01 G/L and CIBLE score were 84%-49% and 72%-62%, respectively with equivalent AUCs (0.66 and 0.67). CONCLUSION Eosinophil count < 0.01 G/L is a simple, routinely used and inexpensive tool which can easily participate in antibiotic decisions for older adults. Further studies are needed to assess clinical benefits. TRIAL REGISTRATION The study was registered at Clinical trial.gov (NCT04363138-23/04/2020).
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Affiliation(s)
- Léa Mésinèle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Tom Pujol
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nicoletta Brunetti
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Marie Neiss
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Christophe Trivalle
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Cecile Souques
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Nadège Houenou-Quenum
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Sébastien Verdier
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Pauline Simon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Anne-Laure Vetillard
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Julie Houdre
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Rocco Collarino
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Morgane Mary
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Jean-Sébastien Vidal
- Département de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Broca, Paris, France
- Université Paris Descartes, INSERM, Paris, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, APHP, Ambroise Paré Hospital, Université de Versailles-Saint- Quentin en Yvelines, Yvelines, France
| | - Magali Guichardon
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
| | - Emmanuelle Duron
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France
| | - Edouard Baudouin
- Service Hospitalo-Universitaire de gériatrie. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris- Saclay, Hôpital Paul-Brousse- Villejuif FR, 12 Avenue Paul Vaillant Couturier, Villejuif, 94800, France.
- CESP, Team MOODS, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, France.
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Jakhar R, Khichi A, Kumar D, Sura K, Bhoomika, Dangi M, Chhillar AK. Development of pharmacophore model to identify potential DNA gyrase inhibitors. J Biomol Struct Dyn 2023; 41:10125-10135. [PMID: 36473713 DOI: 10.1080/07391102.2022.2153171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
There is great concern in the medical community due to rapid increase in antibiotic resistance, causing 700,000 deaths annually worldwide. Therefore, there is paramount need to develop novel and innovative antibacterial agents active against resistant bacterial strains. DNA gyrase is a crucial enzyme in bacterial replication that is absent in eukaryotes, making it effective curative target for antibacterials. To identify potential DNA gyrase inhibitors by virtual screening of NCI database using a 3-step approach. A total of 271 compounds with known IC50 values against Escherichia coli DNA GyrA were selected to develop a pharmacophore model for dual screening approach to identify new potential hits from the NCI database. In the second step, the NCI database was also screened using in-house built NN-QSAR model. Molecular docking of common 5298 compounds screened from both methods were performed against E. coli DNA GyrA (PDB id- 6RKU), and 3004 compounds are reported to exhibit lower binding energies than ciprofloxacin (-6.77 Kcal/mol). The top three compounds (NCI371878, NCI371876 and NCI142159) reported with binding energy of -13.5, -13.19 and -13.03 Kcal/mol were further subjected to MD simulation studies for 100 ns supporting the stability of the docked complexes.
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Affiliation(s)
- Ritu Jakhar
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
| | - Alka Khichi
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
| | - Dev Kumar
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
| | - Kiran Sura
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
| | - Bhoomika
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
| | - Mehak Dangi
- Centre for Bioinformatics, Maharshi Dayanand University, Rohtak, India
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Hugger SS, Do TP, Ashina H, Goicochea MT, Jenkins B, Sacco S, Lee MJ, Brennan KC, Amin FM, Steiner TJ, Ashina M. Migraine in older adults. Lancet Neurol 2023; 22:934-945. [PMID: 37717587 DOI: 10.1016/s1474-4422(23)00206-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/20/2023] [Accepted: 05/23/2023] [Indexed: 09/19/2023]
Abstract
Migraine is an evolving, and sometimes lifelong disorder. The prevalence of episodic migraine peaks among individuals aged in their late 30s, implying a tendency for the disorder to remit with increasing age thereafter, whereas chronic migraine is more likely to persist into later life. Diagnosis and treatment of migraine in older adults, defined as individuals aged 60 years or older, is rendered more complex by increasing probabilities of atypical clinical features and comorbidities, with patients' comorbidities sometimes limiting their therapeutic options. However, the changing clinical presentation of migraine over an individual's lifespan is not well characterised. The neurobiological basis of remission in older adults remains unclear, although vascular, neuronal, and hormonal changes are likely to be involved. Long-term longitudinal studies of individuals with migraine would be particularly informative, with the potential not only to suggest new research directions, but also to lead to the identification of novel therapeutic agents. Although several novel migraine medications are becoming available, their effectiveness, tolerability, and safety often remain uncertain in older adults, who have commonly been excluded from the evaluation of these agents in randomised controlled trials, or who constitute only a small proportion of study populations. There is a need to recognise these limitations in the available evidence, and the specific, and often unmet, clinical needs of older adults with migraine, not least because older adults constitute an increasing proportion of populations worldwide.
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Affiliation(s)
- Sarah Sonja Hugger
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Thien Phu Do
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - K C Brennan
- Headache Physiology Laboratory, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Timothy J Steiner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan.
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Ordóñez JE, Ordóñez A. A cost-effectiveness analysis of pneumococcal conjugate vaccines in infants and herd protection in older adults in Colombia. Expert Rev Vaccines 2023; 22:216-225. [PMID: 36812426 DOI: 10.1080/14760584.2023.2184090] [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: 02/24/2023]
Abstract
BACKGROUND Pneumococcal diseases have a clinical and economic impact on the population. Until this year, a 10-valent pneumococcal vaccine (PCV10) used to be applied in Colombia, which does not contain serotypes 19A, 3, and 6A, the most prevalent in the country. Therefore, we aimed to assess the cost-effectiveness of the shift to the 13-valent pneumococcal vaccine (PCV13). RESEARCH DESIGN AND METHODS A decision model was used for newborns in Colombia between 2022-2025 and adults over 65 years. The time horizon was life expectancy. Outcomes are Invasive Pneumococcal Diseases (IPD), Community-Acquired Pneumonia (CAP), Acute Otitis Media (AOM), their sequelae, Life Gained Years (LYGs), and herd effect in older adults. RESULTS PCV10 covers 4.27% of serotypes in the country, while PCV13 covers 64.4%. PCV13 would avoid in children 796 cases of IPD, 19,365 of CAP, 1,399 deaths, and generate 44,204 additional LYGs, as well as 9,101 cases of AOM, 13 cases of neuromotor disability and 428 cochlear implants versus PCV10. In older adults, PCV13 would avoid 993 cases of IPD and 17,245 of CAP, versus PCV10. PCV13 saves $51.4 million. The decision model shows robustness in the sensitivity analysis. CONCLUSION PCV13 is a cost-saving strategy versus PCV10 to avoid pneumococcal diseases.
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Affiliation(s)
| | - Angélica Ordóñez
- Instituto de Evaluación Tecnológica en Salud, Bogotá, D.C, Colombia
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Zhong YM, Zhang XH, Ma Z, Liu WE. Prevalence of Escherichia coli ST1193 Causing Intracranial Infection in Changsha, China. Trop Med Infect Dis 2022; 7:tropicalmed7090217. [PMID: 36136628 PMCID: PMC9504535 DOI: 10.3390/tropicalmed7090217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
ST1193 is an emerging new virulent and resistant clone among Escherichia coli with a tendency to spread rapidly across the globe. However, the prevalence of intracranial infection-causing E. coli ST1193 is rarely reported. This study aimed at determining the prevalence of E. coli ST1193 isolates, causing intracranial infections in Changsha, central China. A total of 28 E. coli isolates were collected from the cerebrospinal fluid of patients with intracranial infection over a four-year period. All isolates were differentiated using multilocus sequence typing (MLST), and phylogenetic grouping, and tested for antibiotic resistance. MLST analysis showed 11 sequence types (ST) among the 28 E. coli isolates. The most prevalent ST was B2-ST1193 (28.6%, 8/28), followed by B2-ST131 (21.4%, 6/28) and F-ST648 (10.7%, 3/28). Of the eight ST1193 isolates, three carried CTX-M-55, and one carried CTX-M-27. All eight ST1193 isolates were resistant to Ciprofloxacin, showing gyrA1AB/parC4A mutations. Two ST1193 isolates carried the aac(6′)-Ib-cr gene. All ST1193 isolates were recovered from infants with meningitis, with a fatal outcome for one three-month-old infant. ST1193 has emerged as the predominant type of E. coli strain causing intracranial infections in Changsha, China. This study highlights the importance of implementing appropriate surveillance measures to prevent the spread of this emerging public health threat.
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Affiliation(s)
- Yi-Ming Zhong
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiao-He Zhang
- Faculty of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Zheng Ma
- Faculty of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Wen-En Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Correspondence: ; Tel.: +86-731-84327437
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Kong WY, Marawar R. Acute symptomatic seizures and status epilepticus in older adults: A narrative review focusing on management and outcomes. Front Neurol 2022; 13:954986. [PMID: 36090864 PMCID: PMC9458973 DOI: 10.3389/fneur.2022.954986] [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: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
A clear narrative of acute symptomatic seizures (ASyS) in older adults is lacking. Older adults (≥60 years) have the highest incidence of seizures of all age groups and necessitate a tailored approach. ASyS has a bimodal peak in infancy and old age (82.3–123.2/100,000/year after 65 years of age). ASyS can represent half of the new-onset seizures in older adults and can progress to acute symptomatic status epilepticus (ASySE) in 52–72% of the patients. Common etiologies for ASyS in older adults include acute stroke and metabolic disturbances. For ASySE, common etiologies are acute stroke and anoxic brain injury (ABI). Initial testing for ASyS should be consistent with the most common and urgent etiologies. A 20-min electroencephalogram (EEG) is less sensitive in older adults than in younger adults and might not help predict chronic epilepsy. The prolonged postictal phase is an additional challenge for acute management. Studies note that 30% of older adults with ASyS subsequently develop epilepsy. The risk of wrongly equating ASyS as the first seizure of epilepsy is higher in older adults due to the increased long-term challenges with chronic anti-seizure medication (ASM) treatment. Specific challenges to managing ASyS in older adults are related to their chronic comorbidities and polypharmacy. It is unclear if the prognosis of ASyS is dependent on the underlying etiology. Short-term mortality is 1.6 to 3.6 times higher than younger adults. ASySE has high short-term mortality, especially when it is secondary to acute stroke. An acute symptomatic etiology of ASySE had five times increased risk of short-term mortality compared to other types of etiology.
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Farias LABG, Stolp ÂMV, Bandeira SP, Mesquita RF, Bessa PPDN, de Holanda PEL, Costa SF, Takeda CFV, Perdigão LV. Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites. Rev Inst Med Trop Sao Paulo 2022; 64:e33. [PMID: 35544911 PMCID: PMC9084465 DOI: 10.1590/s1678-9946202264033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.
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Affiliation(s)
- Luís Arthur Brasil Gadelha Farias
- Secretaria de Saúde do Estado do Ceará, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Ângela Maria Veras Stolp
- Laboratório Central de Saúde Pública do Estado do Ceará, Setor de Microbiologia, Fortaleza, Ceará, Brazil
- Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | | | | | | | | | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Christianne Fernandes Valente Takeda
- Secretaria de Saúde do Estado do Ceará, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Lauro Vieira Perdigão
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
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9
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Schütze S, Döpke A, Kellert B, Seele J, Ballüer M, Bunkowski S, Kreutzfeldt M, Brück W, Nau R. Intracerebral Infection with E. coli Impairs Spatial Learning and Induces Necrosis of Hippocampal Neurons in the Tg2576 Mouse Model of Alzheimer’s Disease. J Alzheimers Dis Rep 2022; 6:101-114. [PMID: 35530117 PMCID: PMC9028720 DOI: 10.3233/adr-210049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background: In patients with Alzheimer’s disease (AD), bacterial infections are often associated with a cognitive decline. Animal models of genuine acute infections with viable bacteria which induce deterioration of neurodegenerative diseases are missing. Objective: We assessed the effect of an intracerebral infection with E. coli in a mouse model of AD. Methods: 13-month-old Tg2576 +/- mice and transgene negative littermates (Tg2576 -/-) received an intracerebral injection with E. coli K1 or saline followed by treatment with ceftriaxone starting 41 h post infection (p.i.) for 5 days. For 4 weeks, mice were monitored for clinical status, weight, motor functions, and neuropsychological status using the Morris water maze. ELISAs, stainings, and immunohistochemistry in brains were performed at the end of the experiment. Results: Mortality of the infection was approximately 20%. After 4 weeks, spatial learning of infected Tg2576 +/- mice was compromised compared to non-infected Tg2576 +/- mice (p < 0.05). E. coli infection did not influence spatial learning in Tg2576 -/- mice, or spatial memory in both Tg2576 +/- and -/- mice within 4 weeks p.i.. Necrosis of hippocampal neurons was induced in infected compared to non-infected Tg2576 +/- mice 4 weeks p.i., whereas brain concentrations of Aβ1–40, Aβ1–42, and phosphoTau as well as axonal damage and microglia density were not altered. Conclusion: Here, we proved in principle that a genuine acute bacterial infection can worsen cognitive functions of AD mice. Mouse models of subacute systemic infections are needed to develop new strategies for the treatment of bacterial infections in patients with AD in order to minimize their cognitive decline.
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Affiliation(s)
- Sandra Schütze
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Department of Geriatrics, Neurogeriatric Section, AGAPLESION Frankfurter Diakonie Kliniken, Frankfurt, Germany
| | - Anika Döpke
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Benedikt Kellert
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jana Seele
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Melissa Ballüer
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephanie Bunkowski
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mario Kreutzfeldt
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Department of Pathology and Immunology, University of Geneva and Division of Clinical Pathology, Geneva University Hospital, Centre Médical Universitaire, Geneva, Switzerland
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Nau
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
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10
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Bhattarai S, Sharma BK, Subedi N, Ranabhat S, Baral MP. Burden of Serious Bacterial Infections and Multidrug-Resistant Organisms in an Adult Population of Nepal: A Comparative Analysis of Minimally Invasive Tissue Sampling Informed Mortality Surveillance of Community and Hospital Deaths. Clin Infect Dis 2021; 73:S415-S421. [PMID: 34910184 PMCID: PMC8672751 DOI: 10.1093/cid/ciab773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bacterial diseases are the leading cause of mortality globally, and due to haphazard use of antibiotics, antimicrobial resistance has become an emerging threat. METHODS This cross-sectional observational study utilized a minimally invasive tissue sampling procedure to determine the cause of death among an adult population. Bacterial cultures (blood, cerebrospinal fluid, lung tissue) and antibiotic susceptibility were evaluated, and the results were compared between community and hospital deaths. RESULTS Of 100 deceased persons studied, 76 (76%) deaths occurred in the community and 24 (24%) in the hospital. At least 1 bacterial agent was cultured from 86 (86%) cases; of these, 74 (86%) had a bacterial disease attributed as the primary cause of death, with pneumonia (35, 47.3%), sepsis (33, 44.6%), and meningitis (3, 4.1%) most common. Of 154 bacterial isolates (76.6% from the community and 23.4% from the hospital) detected from 86 culture-positive cases, 26 (16.8%) were multidrug-resistant (MDR). Klebsiella species were the most common (13 of 26) MDR organisms. The odds of getting an MDR Klebsiella infection was 6-fold higher among hospital deaths compared with community deaths (95% confidence interval [CI], 1.37-26.40; P = .017) and almost 23-fold higher (CI, 2.45-213.54; P = .006) among cases with prior antibiotic use compared to those without. CONCLUSIONS High incidence of serious bacterial infections causing death of adults in the community, with most MDR organisms isolated from hospitalized cases, calls for robust surveillance mechanisms and infection prevention activities at the community level and evidence-driven antibiotic stewardship in healthcare settings.
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Affiliation(s)
- Suraj Bhattarai
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Binita Koirala Sharma
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Microbiology, GMCTHRC, Pokhara, Nepal.,Department of Microbiology, Tribhuvan University Prithvi Narayan Campus, Pokhara, Nepal
| | - Nuwadatta Subedi
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Forensic Medicine, GMCTHRC, Pokhara, Nepal
| | - Sunita Ranabhat
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Pathology, GMCTHRC, Pokhara, Nepal
| | - Madan Prasad Baral
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Forensic Medicine, Pokhara Academy of Health Sciences, Western Regional Hospital, Pokhara, Nepal
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11
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Eagles D, Khoujah D. Rapid Fire: Acute Brain Failure in Older Emergency Department Patients. Emerg Med Clin North Am 2021; 39:287-305. [PMID: 33863460 DOI: 10.1016/j.emc.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Delirium is common in older emergency department (ED) patients. Although associated with significant morbidity and mortality, it often goes unrecognized. A consistent approach to evaluation of mental status, including use of validated tools, is key to diagnosing delirium. Identification of the precipitating event requires thorough evaluation, including detailed history, medication reconciliation, physical examination, and medical work-up, for causes of delirium. Management is aimed at identifying and treating the underlying cause. Meaningful improvements in delirium care can be achieved when prevention, identification, and management of older delirious ED patients is integrated by physicians and corresponding frameworks implemented at the health system level.
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Affiliation(s)
- Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Danya Khoujah
- Emergency Medicine, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. https://twitter.com/DanyaKhoujah
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12
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Nakamura Y, Uemura T, Kawata Y, Hirose B, Yamauchi R, Shimohama S. Streptococcus oralis Meningitis with Gingival Bleeding in a Patient: A Case Report and Review of the Literature. Intern Med 2021; 60:789-793. [PMID: 32999235 PMCID: PMC7990632 DOI: 10.2169/internalmedicine.5628-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 81-year-old man with a history of gingival bleeding presented with a fever, headache, and drowsiness. His mouth and full dentures were unsanitary. Laboratory tests revealed Streptococcus oralis meningitis caused by odontogenic bacteremia. We reviewed eight reported cases, including the present case, because S. oralis meningitis is rare. Our review indicated that S. oralis meningitis needs to be considered when encountering cases of a fever, disturbance of consciousness, and headache with episodes of possible odontogenic bacteremia.
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Affiliation(s)
- Yuki Nakamura
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Tomohiro Uemura
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Yuka Kawata
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Bungo Hirose
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Rika Yamauchi
- Department of Neurology, Sunagawa City Medical Center, Japan
| | - Shun Shimohama
- Department of Neurology, Sapporo Medical University, Japan
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13
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Abstract
The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.
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Affiliation(s)
- Danya Khoujah
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca St, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Emergency Medicine, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA.
| | - Megan J Cobb
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca St, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Maryland Emergency Medicine Network, Upper Chesapeake Emergency Medicine, 500 Upper Chesapeake Drive, Bel Air, MD 21014, USA
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14
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Fellner A, Goldstein L, Lotan I, Keret O, Steiner I. Meningitis without meningeal irritation signs: What are the alerting clinical markers? J Neurol Sci 2020; 410:116663. [DOI: 10.1016/j.jns.2019.116663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/04/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022]
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15
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Sharma S, Acharya J, Caugant DA, Thapa J, Bajracharya M, Kayastha M, Sharma S, Chalise BS, Karn R, Banjara MR, Ghimire P, Singh A. Meningococcal Meningitis: A Multicentric Hospital-based Study in Kathmandu, Nepal. Open Microbiol J 2019. [DOI: 10.2174/1874285801913010273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background:
The global epidemiology of meningococcal disease varies markedly by region and over time. In Nepal, information on serogroup of meningococci is not available since the 1983 serogroup A epidemic in Kathmandu.
Objective:
To provide some fundamental data on the circulating serogroups of meningococci for potential meningococcal immunization programs in Nepal.
Methods:
This cross-sectional prospective study was conducted from January 2017 to December 2018 among 387 clinically suspected meningitis cases. Cerebrospinal fluid samples were collected by lumbar puncture technique at five referral hospitals of Kathmandu and processed by conventional cultural techniques. Neisseria meningitidis was identified by colony morphology, Gram staining and oxidase test. Serogrouping of meningococci was performed by slide agglutination test. Antibiotic susceptibility testing was done by the modified Kirby Bauer disc diffusion method. The data was entered into IBM SPSS Statistics 21 software and a p-value of <0.05 was considered significant.
Results:
Thirty-two samples were positive by culture for a bacterial pathogen with 2.3% of meningococci. All except one meningococcal meningitis cases were aged below 15 years. All N.meningitidis isolates belonged to serogroup A and were susceptible to ceftriaxone, chloramphenicol, meropenem and minocycline; however, 22% isolates showed resistance to cotrimoxazole and 11% intermediate resistance to ciprofloxacin.
Conclusion:
The circulating serogroup of N. meningitidis in Kathmandu has not changed over the past 35 years. The prevalence of meningococcal meningitis in Kathmandu is low but might be underestimated due to the sole use of culture-based diagnostic methods. Detection of meningococci by alternative methods may be useful in the precise estimation of actual disease burden.
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16
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Affiliation(s)
- Bryony Alderman
- Foundation Year 2 Doctor, Department of Elderly Care, Lister Hospital, Stevenage
| | - Lucy-Anne Frank
- ST4 in Geriatric and Internal Medicine, Department of Elderly Care, Lister Hospital, Stevenage SG1 4AB
| | - Shahid A Khan
- Consultant Geriatrician and Director of Medical Education, Department of Elderly Care, Lister Hospital, Stevenage
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17
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Haydar SM, Hallit SR, Hallit RR, Salameh PR, Faddoul LJ, Chahine BA, Malaeb DN. Adherence to international guidelines for the treatment of meningitis infections in Lebanon. Saudi Med J 2019; 40:260-265. [PMID: 30834421 PMCID: PMC6468200 DOI: 10.15537/smj.2019.3.23965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives: To assess meningitis treatment in Lebanon’s compatibility with the Infectious Diseases Society of America (IDSA) guidelines and the effect of non-compliance on mortality. Methods: This is a retrospective study, conducted in 5 Lebanese hospitals, and enrolling all patients diagnosed with meningitis who presented to the involved hospitals from January 2008 to December 2016. Results: A total of 252 participants were enrolled in the study. Of these patients, 205 (82.7%) were diagnosed with viral meningitis and 47 (17.3%) with bacterial meningitis, which was confirmed using laboratory tests. For patients with viral meningitis, 128 (62.4%) remained on the initial prescribed antibiotics despite the negative cerebrospinal fluid (CSF) and blood culture results. For bacterial meningitis patients, 30.8% received treatment regimen incompatible with the IDSA guidelines. The most common reason for the treatment incompatibility was the definitive drug choice after the culture results (49.1%) and the least common reason was inappropriate hospital stay days (25.9%). The mortality rate was 13.5%. Having low proteins values in the CSF (odds ratio=0.095) was associated with lower mortality compared to patients with normal protein values. Conclusion: This study shows a high percentage of inappropriate treatment in Lebanese hospitals despite these hospitals having adopted international treatment guidelines. This inappropriate management was associated with an increasing rate of mortality and neurological complications.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Cerebrospinal Fluid Proteins
- Child
- Child, Preschool
- Female
- Guideline Adherence
- Hospitals/standards
- Humans
- Infant
- Infant, Newborn
- Lebanon/epidemiology
- Male
- Medication Errors
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/drug therapy
- Meningitis, Bacterial/mortality
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/complications
- Meningitis, Viral/drug therapy
- Meningitis, Viral/mortality
- Middle Aged
- Practice Guidelines as Topic
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Sahar M Haydar
- School of Pharmacy, Lebanese University, Beirut, Lebanon. E-mail.
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18
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A proposal for distinguishing between bacterial and viral meningitis using genetic programming and decision trees. Soft comput 2019. [DOI: 10.1007/s00500-018-03729-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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19
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Diesselberg C, Ribes S, Seele J, Kaufmann A, Redlich S, Bunkowski S, Hanisch UK, Michel U, Nau R, Schütze S. Activin A increases phagocytosis of Escherichia coli K1 by primary murine microglial cells activated by toll-like receptor agonists. J Neuroinflammation 2018; 15:175. [PMID: 29880000 PMCID: PMC5992782 DOI: 10.1186/s12974-018-1209-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Bacterial meningitis is associated with high mortality and long-term neurological sequelae. Increasing the phagocytic activity of microglia could improve the resistance of the CNS against infections. We studied the influence of activin A, a member of the TGF-β family with known immunoregulatory and neuroprotective effects, on the functions of microglial cells in vitro. Methods Primary murine microglial cells were treated with activin A (0.13 ng/ml–13 μg/ml) alone or in combination with agonists of TLR2, 4, and 9. Phagocytosis of Escherichia coli K1 as well as release of TNF-α, IL-6, CXCL1, and NO was assessed. Results Activin A dose-dependently enhanced the phagocytosis of Escherichia coli K1 by microglial cells activated by agonists of TLR2, 4, and 9 without further increasing NO and proinflammatory cytokine release. Cell viability of microglial cells was not affected by activin A. Conclusions Priming of microglial cells with activin A could increase the elimination of bacteria in bacterial CNS infections. This preventive strategy could improve the resistance of the brain to infections, particularly in elderly and immunocompromised patients.
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Affiliation(s)
- Catharina Diesselberg
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Sandra Ribes
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jana Seele
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany
| | - Annika Kaufmann
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Sandra Redlich
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Stephanie Bunkowski
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Uwe-Karsten Hanisch
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Uwe Michel
- Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Roland Nau
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.,Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany
| | - Sandra Schütze
- Institute of Neuropathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. .,Department of Geriatrics, AGAPLESION Frankfurter Diakonie Kliniken, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Germany.
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20
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Song Y, Wang B, Song R, Hao Y, Wang D, Li Y, Jiang Y, Xu L, Ma Y, Zheng H, Kong Y, Zeng H. T-cell Immunoglobulin and ITIM Domain Contributes to CD8 + T-cell Immunosenescence. Aging Cell 2018; 17:e12716. [PMID: 29349889 PMCID: PMC5847879 DOI: 10.1111/acel.12716] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 02/02/2023] Open
Abstract
Aging is associated with immune dysfunction, especially T-cell defects, which result in increased susceptibility to various diseases. Previous studies showed that T cells from aged mice express multiple inhibitory receptors, providing evidence of the relationship between T-cell exhaustion and T-cell senescence. In this study, we showed that T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), a novel co-inhibitory receptor, was upregulated in CD8+ T cells of elderly adults. Aged TIGIT+ CD8+ T cells expressed high levels of other inhibitory receptors including PD-1 and exhibited features of exhaustion such as downregulation of the key costimulatory receptor CD28, representative intrinsic transcriptional regulation, low production of cytokines, and high susceptibility to apoptosis. Importantly, their functional defects associated with aging were reversed by TIGIT knockdown. CD226 downregulation on aged TIGIT+ CD8+ T cells is likely involved in TIGIT-mediated negative immune suppression. Collectively, our findings indicated that TIGIT acts as a critical immune regulator during aging, providing a strong rationale for targeting TIGIT to improve dysfunction related to immune system aging.
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Affiliation(s)
- Yangzi Song
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Beibei Wang
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Rui Song
- Beijing Key Laboratory of Emerging Infectious DiseasesThe National Clinical Key Department of Infectious DiseaseBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Yu Hao
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Di Wang
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Yuxin Li
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Yu Jiang
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Ling Xu
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Yaluan Ma
- Lab for Molecular BiologyInstitute of Basic Theory on Chinese MedicineChina Academy of Chinese Medical SciencesBeijingChina
| | - Hong Zheng
- Penn State Hershey Cancer InstitutePenn State University College of MedicineHersheyPAUSA
| | - Yaxian Kong
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Hui Zeng
- Beijing Key Laboratory of Emerging Infectious DiseasesInstitute of Infectious DiseasesBeijing Ditan HospitalCapital Medical UniversityBeijingChina
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21
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Abstract
The thermoregulatory functions may vary with age. Thermosensitivity is active in neonates and children; both heat production and heat loss effector mechanisms are functional but easily exhaustable. Proportional and lasting defense against thermal challenges is difficult, and both hypothermia and hyperthermia may easily develop. Febrile or hypothermic responses to infections or endotoxin can also develop, together with confusion. In small children febrile convulsions may be dangerous. In old age the resting body temperature may be lower than in young adults. Further, thermosensitivity decreases, the thresholds for activating skin vasomotor and evaporative responses or metabolism are shifted, and responses to thermal challenges are delayed or insufficient: both hypothermia and hyperthermia may develop easily. Infection-induced fevers are often limited or absent, or replaced by hypothermia. Various types of brain damage may induce special forms of hypothermia, hyperthermia, or severe fever. Impaired mental state often accompanies hypothermia and hyperthermia, and may occasionally be a dominant feature of infection (instead of the most commonly observed fever). Aging brings about a turning point in women's life: the menopause. The well-known influence of regular hormonal cycles on the thermoregulation of a woman of fertile age gives way to menopausal hot flushes caused by estrogen withdrawal. Not all details of this thermoregulatory anomaly are fully understood yet.
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22
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Srihawan C, Habib O, Salazar L, Hasbun R. Healthcare-Associated Meningitis or Ventriculitis in Older Adults. J Am Geriatr Soc 2017; 65:2646-2650. [PMID: 28975609 DOI: 10.1111/jgs.15099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Older adults are at higher risk of adverse outcomes in community-acquired meningitis but studies of HCAMV are lacking. Therefore, we perform the study to define the differences in clinical outcomes between older and younger adults with HCAMV. DESIGN Retrospective study. SETTING A large tertiary care hospital in Houston, Texas, from July 2003 to November 2014. PARTICIPANTS Adults with a diagnosis of HCAMV (N = 160) aged ≥65 (n = 35), aged 18-64 (n = 125). MEASUREMENTS Demographic characteristics, clinical presentation, laboratory results, treatments, and outcomes (Glasgow Outcome Scale). RESULTS Older adults had more comorbidities and CSF abnormalities [pleocytosis, high cerebrospinal fluid (CSF) protein, low CSF glucose) and were more likely to have altered mental status than younger adults (P < .05). An adverse clinical outcome was seen in 142 participants (89%) (death (n = 18, 11%), persistent vegetative state (n = 26, 16%), severe disability (n = 68, 43%), moderate disability (n = 30, 19%). There was no difference in adverse outcomes between older (97%) and younger (86%) adults (P = .13). On logistic regression analysis, abnormal neurological examination (adjusted odds ratio (aOR) = 7.13, 95% confidence interval (CI) = 2.15-23.63, P = .001) and mechanical ventilation (aOR = 11.03, 95% CI = 1.35-90.51, P = .02) were associated with adverse clinical outcomes. CONCLUSION Older adults with HCAMV have more comorbidities and CSF abnormalities and are more likely to have altered mental status than younger adults but have similar high rates of adverse clinical outcomes.
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Affiliation(s)
- Chanunya Srihawan
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Onaizah Habib
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Lucrecia Salazar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rodrigo Hasbun
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas
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23
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Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study. Clin Microbiol Infect 2017; 24:166-170. [PMID: 28652113 DOI: 10.1016/j.cmi.2017.06.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine clinical characteristics and outcome of patients with late diagnosis of community-acquired bacterial meningitis (CABM). METHODS We conducted a chart review of all adults with proven CABM in three centres in Denmark from 1998 through to 2014. Patients were categorized as early diagnosis of CABM immediately on admission, or late diagnosis if CABM was not listed in referral or admission records and neither lumbar puncture nor antibiotic therapy for meningitis was considered immediately on admission. We used modified Poisson regression analysis to compute adjusted relative risks with 95% CIs for predictors of late diagnosis and in-hospital mortality. RESULTS A total of 113/358 (32%) patients were categorized as late diagnosis demonstrating a variety of tentative diagnoses of which 81/113 (72%) were non-infectious. We observed several statistically significant baseline differences (p <0.05) in patients with late versus early diagnosis including age >65 years (56/113, 50% versus 67/245, 27%), neck stiffness (35/97, 36% versus 183/234, 78%), concomitant pneumonia (26/113, 23% versus 26/245, 11%), and meningococcal meningitis (6/113, 5% versus 52/245, 21%). These variables remained statistically significant in multivariate analysis. Moreover, late diagnosis was associated with increased in-hospital mortality (41/113, 36% versus 43/245, 18%; adjusted relative risk 1.7, 95% CI 1.2-2.5). CONCLUSIONS Late diagnosis of CABM was common and patients were admitted with mostly non-infectious diagnoses. Absence of neck stiffness did not rule out CABM and special attention should be given to patients with pneumonia and the elderly. Late diagnosis was associated with incorrect patient management and increased mortality.
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Abstract
BACKGROUND Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. METHODS We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. RESULTS We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. CONCLUSIONS As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease.
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Affiliation(s)
- Lene Fogt Lundbo
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
| | - Thomas Benfield
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
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Shi ZH, Xu M, Wang YZ, Luo XY, Chen GQ, Wang X, Wang T, Tang MZ, Zhou JX. Post-craniotomy intracranial infection in patients with brain tumors: a retrospective analysis of 5723 consecutive patients. Br J Neurosurg 2016; 31:5-9. [PMID: 27845572 DOI: 10.1080/02688697.2016.1253827] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To determine the risk factors for and the incidence, outcomes, and causative pathogens of post-craniotomy intracranial infection (PCII) in patients with brain tumors. METHODS A retrospective study was performed of 5723 patients with brain tumors who were surgically treated between January 2012 and December 2013 in Beijing Tiantan Hospital. The patients' demographics, pathohistological diagnoses, surgical procedures, postoperative variables, causative pathogens, and outcomes were evaluated. RESULTS The overall incidence of PCII was 6.8%, and 82.1% of all cases were diagnosed within two weeks after the craniotomy. Postoperative administration of antibiotics reduced the incidence of PCII. Independent risk factors included clean-contaminated craniotomy, prolonged operation (> 7 h), external cerebrospinal fluid (CSF) drainage/monitoring device placement, and postoperative CSF leakage. Patients ≤ 45 years old were more susceptible to infection. Compared with supratentorial tumors, tumors located in the infratentorial or intraventricular regions were more vulnerable to PCII. Gram-positive bacteria were the most common causative pathogens isolated from the CSF samples, accounting for 82.0% of the PCII cases. CONCLUSIONS Risk factors for PCII can be identified early in the perioperative period. These findings raise the possibility of improving the clinical outcomes of patients with brain tumors who undergo craniotomy.
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Affiliation(s)
- Zhong-Hua Shi
- a Department of Critical Care Medicine , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Ming Xu
- a Department of Critical Care Medicine , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Yong-Zhi Wang
- b Department of Neurosurgery , Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University , Beijing , PR China
| | - Xu-Ying Luo
- a Department of Critical Care Medicine , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Guang-Qiang Chen
- a Department of Critical Care Medicine , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Xin Wang
- c Information Center, Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Tao Wang
- c Information Center, Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Ming-Zhong Tang
- d Department of Clinical Laboratory , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
| | - Jian-Xin Zhou
- a Department of Critical Care Medicine , Beijing Tiantan Hospital, Capital Medical University , Beijing , PR China
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Gray JD, Wilson CJ. Streptococcus gallolyticus (bovis): a rare presentation of meningitis in the ED. Am J Emerg Med 2016; 34:677.e1. [PMID: 26259921 DOI: 10.1016/j.ajem.2015.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/21/2015] [Indexed: 12/14/2022] Open
Abstract
Bacterial meningitis is a fairly common and often deadly manifestation of altered mental status in the elderly, carrying a mortality rate of greater than 20% despite antibiotic therapy. Most commonly caused by Streptococcus pneumoniae, Listeria monocytogenes, Escherichia coli, and Klebsiella pneumoniae. We present a case of meningitis caused by Streptococcus gallolyticus in an elderly, otherwise healthy woman. There have been no reports in the emergency medicine literature and only a few reports in the literature of S gallolyticus as a cause of altered mental status and meningitis, specifically of immunocompetent patients.
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Affiliation(s)
- Joshua D Gray
- Department of Emergency Medicine, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822
| | - Christopher J Wilson
- Department of Emergency Medicine, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822
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The Optimal Management of Acute Febrile Encephalopathy in the Aged Patient: A Systematic Review. Interdiscip Perspect Infect Dis 2016; 2016:5273651. [PMID: 26989409 PMCID: PMC4773559 DOI: 10.1155/2016/5273651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 11/17/2022] Open
Abstract
The elderly comprise less than 13 percent of world population. Nonetheless, they represent nearly half of all hospitalized adults. Acute change in mental status from baseline is commonly seen among the elderly even when the main process does not involve the central nervous system. The term "geriatric syndrome" is used to capture those clinical conditions in older people that do not fit into discrete disease categories, including delirium, falls, frailty, dizziness, syncope, and urinary incontinence. Despite the growing number of elderly population, especially those who require hospitalization and the high burden of common infections accompanied by encephalopathy among them, there are several unresolved questions regarding the optimal management they deserve. The questions posed in this systematic review concern the need to rule out CNS infection in all elderly patients presented with fever and altered mental status in the routine management of febrile encephalopathy. In doing so, we sought to identify all potentially relevant articles using searches of web-based databases with no language restriction. Finally, we reviewed 93 research articles that were relevant to each part of our study. No prospective study was found to address how should AFE in the aged be optimally managed.
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Wang AY, Machicado JD, Khoury NT, Wootton SH, Salazar L, Hasbun R. Community-acquired meningitis in older adults: clinical features, etiology, and prognostic factors. J Am Geriatr Soc 2014; 62:2064-70. [PMID: 25370434 PMCID: PMC4241151 DOI: 10.1111/jgs.13110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the epidemiology and outcomes of community-acquired meningitis in older adults. DESIGN Retrospective study. SETTING Participants adults in Houston, Texas, with community-acquired meningitis hospitalized between January 1, 2005, and January 1, 2010 (N = 619; n = 54, 8.7%, aged ≥65; n = 565 aged <65). METHODS An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. RESULTS Older adults had higher rates of comorbidities, abnormal neurological and laboratory (serum white blood cell count >12,000/μL, and cerebrospinal fluid protein >100 mg/dL) findings (P < .001), abnormalities on computed tomography and magnetic resonance imaging of the head (P = .002), and adverse clinical outcomes (ACOs) (P < .001). The majority of participants (65.8%) had meningitis of unknown etiology. Bacterial meningitis was an infrequent cause of community-acquired meningitis (7.4%). Of the known causes, bacterial meningitis and West Nile virus were more common in older than younger adults; younger participants more frequently had cryptococcal and viral meningitis. On logistic regression, female sex was predictive of a poor outcome in the older participants (P = .002), whereas abnormal neurological examination (P < .001), fever (P = .01), and a cerebrospinal fluid glucose level less than 45 mg/dL (P = .002) were significant poor prognostic factors in younger participants. CONCLUSION Most cases of community-acquired meningitis are of unknown origin. Older adults are more likely than younger adults to have bacterial meningitis and West Nile virus infection when a cause can be identified. They also have more neurological abnormalities, laboratory and imaging abnormalities, and adverse clinical outcomes.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Brain/pathology
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/epidemiology
- Community-Acquired Infections/etiology
- Comorbidity
- Cross-Sectional Studies
- Female
- Glasgow Outcome Scale
- Glucose/cerebrospinal fluid
- Humans
- Magnetic Resonance Imaging
- Male
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/epidemiology
- Meningitis, Bacterial/etiology
- Meningitis, Cryptococcal/diagnosis
- Meningitis, Cryptococcal/epidemiology
- Meningitis, Cryptococcal/etiology
- Meningitis, Viral/diagnosis
- Meningitis, Viral/epidemiology
- Meningitis, Viral/etiology
- Middle Aged
- Neurologic Examination
- Prognosis
- Retrospective Studies
- Sex Factors
- Texas
- Tomography, X-Ray Computed
- West Nile Fever/diagnosis
- West Nile Fever/epidemiology
- West Nile Fever/etiology
- Young Adult
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Affiliation(s)
- Amy Y. Wang
- Department of Internal Medicine, University of Texas Health Science Center in Houston
| | - Jorge D. Machicado
- Department of Internal Medicine, University of Texas Health Science Center in Houston
| | - Nabil T. Khoury
- Department of Internal Medicine, University of Texas Health Science Center in Houston
| | - Susan H. Wootton
- Department of Pediatrics, University of Texas Health Science Center in Houston
| | - Lucrecia Salazar
- Department of Internal Medicine, University of Texas Health Science Center in Houston
| | - Rodrigo Hasbun
- Department of Internal Medicine, University of Texas Health Science Center in Houston
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Distribution of strain type and antimicrobial susceptibility of Escherichia coli isolates causing meningitis in a large urban setting in Brazil. J Clin Microbiol 2014; 52:1418-22. [PMID: 24523478 DOI: 10.1128/jcm.03104-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The clinical management of meningitis caused by Escherichia coli is greatly complicated when the organism becomes resistant to broad-spectrum antibiotics. We sought to characterize the antimicrobial susceptibilities, sequence types (ST), and presence of known drug resistance genes of E. coli isolates that caused meningitis between 1996 and 2011 in Salvador, Brazil. We then compared these findings to those for E. coli isolates from community-acquired urinary tract infections (UTI) that occurred during the same time period and in the same city. We found that 19% of E. coli isolates from cases of meningitis and less than 1% of isolates from UTI were resistant to third-generation cephalosporins. The sequence types of E. coli isolates from cases of meningitis included ST131, ST69, ST405, and ST62, which were also found among isolates from UTI. Additionally, among the E. coli isolates that were resistant to third-generation cephalosporins, we found genes that encode the extended-spectrum beta-lactamases CTX-M-2, CTX-M-14, and CTX-M-15. These observations demonstrate that compared to E. coli strains isolated from cases of community-acquired UTI, those isolated from cases of meningitis are more resistant to third-generation cephalosporins, even though the same sequence types are shared between the two forms of extraintestinal infections.
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Steens A, Eriksen HM, Blystad H. What are the most important infectious diseases among those ≥65 years: a comprehensive analysis on notifiable diseases, Norway, 1993-2011. BMC Infect Dis 2014; 14:57. [PMID: 24495775 PMCID: PMC3923236 DOI: 10.1186/1471-2334-14-57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the population ages, the burden on the healthcare system might increase and require changed public health priorities. As infections are often more severe at older age, we rank notifiable infectious diseases (ID) and describe trends of ID among the general population aged ≥65 years in Norway in order to inform public health priorities for the aging population. METHODS We included all eligible cases of the 58 IDs notified between 1993 and 2011 (n = 223,758; 12% ≥65 years) and determined annual notification rates as the number of notified cases divided by the number of inhabitants of the corresponding year. We ranked diseases using their average annual notification rate for 2007-2011. Trends in notification rates from 1993 onwards were determined with a non-parametric test for trend. Using notification rate ratios (NRR), we compared results in those aged ≥65 years to those aged 20-64 years. RESULTS Invasive pneumococcal disease was the most common ID among the population ≥65 years (notification rate 58/100,000), followed by pertussis (54/100,000) and campylobacteriosis (30/100,000). Most ID notification rates did not change over time, though the notification rate of symptomatic MRSA infections increased from 1/100,000 in 1995 (first year of notification) to 14/100,000 in 2011.Overall, fewer cases were notified among the population ≥65 years compared to 20-64 year olds (NRR = 0.73). The NRR of each of the invasive bacterial diseases and antibiotic-resistant infections were above 1.5 (i.e. more common in ≥65), while the NRR of each food- and waterborne disease, blood-borne disease/STI and (non-invasive) vaccine preventable disease was below 1. CONCLUSIONS Based on our results, we emphasise the importance of focusing public health efforts for those ≥65 years on preventing invasive bacterial infections. This can be achieved by increasing pneumococcal and influenza vaccine uptake, and risk communication including encouraging those aged ≥65 years and their caretakers to seek healthcare at signs of systemic infection. Furthermore, good compliance to infection control measures, screening of the at-risk population, and careful use of antibiotics may prevent further increase in antibiotic-resistant infections.
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Affiliation(s)
- Anneke Steens
- Norwegian Institute of Public Health, Oslo, Norway
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Hans Blystad
- Norwegian Institute of Public Health, Oslo, Norway
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Muralidharan R, Mateen FJ, Rabinstein AA. Outcome of fulminant bacterial meningitis in adult patients. Eur J Neurol 2013; 21:447-53. [DOI: 10.1111/ene.12328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Affiliation(s)
- R. Muralidharan
- Department of Neurology; University of Pennsylvania; Philadelphia PA USA
| | - F. J. Mateen
- Department of Neurology; Massachusetts General Hospital; Boston MA USA
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Bouwknegt M, van Pelt W, Havelaar AH. Scoping the impact of changes in population age-structure on the future burden of foodborne disease in the Netherlands, 2020-2060. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2888-96. [PMID: 23851976 PMCID: PMC3734465 DOI: 10.3390/ijerph10072888] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/17/2013] [Accepted: 06/28/2013] [Indexed: 12/18/2022]
Abstract
A demographic shift towards a larger proportion of elderly in the Dutch population in the coming decades might change foodborne disease incidence and mortality. In the current study we focused on the age-specific changes in the occurrence of foodborne pathogens by combining age-specific demographic forecasts for 10-year periods between 2020 and 2060 with current age-specific infection probabilities for Campylobacter spp., non-typhoidal Salmonella, hepatitis A virus, acquired Toxoplasma gondii and Listeria monocytogenes. Disease incidence rates for the former three pathogens were estimated to change marginally, because increases and decreases in specific age groups cancelled out over all ages. Estimated incidence of reported cases per 100,000 for 2060 mounted to 12 (Salmonella), 51 (Campylobacter), 1.1 (hepatitis A virus) and 2.1 (Toxoplasma). For L. monocytogenes, incidence increased by 45% from 0.41 per 100,000 in 2011 to 0.60 per 100,000. Estimated mortality rates increased two-fold for Salmonella and Campylobacter to 0.5 and 0.7 per 100,000, and increased by 25% for Listeria from 0.06 to 0.08. This straightforward scoping effort does not suggest major changes in incidence and mortality for these food borne pathogens based on changes in de population age-structure as independent factor. Other factors, such as changes in health care systems, social clustering and food processing and preparation, could not be included in the estimates.
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Affiliation(s)
- Martijn Bouwknegt
- Centre for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven NL-3720BA, The Netherlands; E-Mail:
| | - Wilfrid van Pelt
- Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven NL-3720BA, The Netherlands; E-Mail:
| | - Arie H. Havelaar
- Centre for Zoonoses and Environmental Microbiology, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven NL-3720BA, The Netherlands; E-Mail:
- Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht NL-3508TD, The Netherlands
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Magazzini S, Nazerian P, Vanni S, Paladini B, Pepe G, Casanova B, Crugnola C, Grifoni S. Clinical picture of meningitis in the adult patient and its relationship with age. Intern Emerg Med 2012; 7:359-64. [PMID: 22419148 DOI: 10.1007/s11739-012-0765-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
To analyze the clinical characteristics of acute meningitis and their relationship with age in adult patients presenting to the emergency department. We retrospectively investigated consecutive adult patients admitted with a diagnosis of bacterial or viral meningitis from 2002 to 2006. Data about patient's history, symptoms and signs at presentation, etiology and clinical course were collected. To investigate the relationship of clinical presentation with age, we divided patients in four age quartiles (<30 years, between 30 and 36 years, between 37 and 56 years, >56 years). Among the 202 patients considered in the study (mean age 42.8 ± 18.7 years, range 14-90), 162 (80.2%) patients had viral and 40 (19.8%) bacterial meningitis. Specific signs, such as neck stiffness or Kernig or Brudzinski signs, were more common in the first than in the fourth quartile (73.1 vs. 45.7% P = 0.041). Conversely, altered consciousness expressed as Glasgow Coma Scale (GCS) <15 was more frequent in the fourth (80.4%) than in the first (9.6%) quartile (P < 0.001). The linear regression analysis confirmed a significant decrease of GCS with the increasing of patient's age (r = -0.69, P < 0.001). At multivariate analysis, aging was associated with altered level of consciousness (OR 16.7, P < 0.001) independent of viral or bacterial etiology of the presence of comorbidities and of clinical severity (presence of severe sepsis or septic shock). Meningitis presentation largely differs with aging in adult patients. Level of consciousness is frequently altered in the older patients, when other specific signs become more rare, independent of etiology, comorbidities and clinical severity.
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Affiliation(s)
- Simone Magazzini
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Zúñiga M, Miranda A, Oñate J, Martínez E, Bolívar G. Múltiples abscesos cerebrales por Listeria monocitogenes en un paciente con infección por el virus de inmunodeficiencia humana, primer caso descrito en Colombia. INFECTIO 2011. [DOI: 10.1016/s0123-9392(11)70075-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010; 23:467-92. [PMID: 20610819 PMCID: PMC2901656 DOI: 10.1128/cmr.00070-09] [Citation(s) in RCA: 511] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.
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Affiliation(s)
- Matthijs C. Brouwer
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
| | - Allan R. Tunkel
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
| | - Diederik van de Beek
- Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey
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Pérez AE, Dickinson FO, Rodríguez M. Community acquired bacterial meningitis in Cuba: a follow up of a decade. BMC Infect Dis 2010; 10:130. [PMID: 20500858 PMCID: PMC2891755 DOI: 10.1186/1471-2334-10-130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 05/25/2010] [Indexed: 12/05/2022] Open
Abstract
Background Community acquired Bacterial Meningitis (BM) remains a serious threat to global health. Cuban surveillance system for BM allowed to characterize the main epidemiological features of this group of diseases, as well as to assess the association of some variables with mortality. Results of the BM surveillance in Cuba are presented in this paper. Methods A follow up of BM cases reported to the Institute "Pedro Kourí" by the National Bacterial Meningitis Surveillance System from 1998 to 2007 was completed. Incidence and case-fatality rate (CFR) were calculated. Univariate analysis and logistic regression were used to elucidate associated factors to mortality comparing death versus survival. Relative Risk (RR) or odds ratio and its 95% confidence interval (CI 95%) were estimated, using either a Chi-squared Test or Fisher's Exact Test as appropriate. A Holt-Winters model was used to assess seasonality. Results 4 798 cases of BM (4.3 per 100 000 population) were reported, with a decreasing trend of the incidence. Highest incidence was observed in infants and elderly. Overall CFR reached 24.1% affecting mostly older adults. S. pneumoniae (23.6%), N. meningitidis(8.2%) and H. influenzaetype b (6.0%) were the main causative agents. Males predominate in the incidence. Highest incidence and CFR were mainly clustered in the centre of the island. The univariate analysis did not show association between delayed medical consultation (RR = 1.20; CI = 1.07-1.35) or delayed hospitalization (RR = 0.98; CI = 0.87-1.11) and the fatal outcome. Logistic regression model showed association of categories housewife, pensioned, imprisoned, unemployed, S. peumoniae and other bacteria with mortality. Seasonality during September, January and March was observed. Conclusions The results of the National Program for Control and Prevention of the Neurological Infectious Syndrome evidenced a reduction of the BM incidence, but not the CFR. Multivariate analysis identified an association of mortality with some societal groups as well as with S. peumoniae.
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Affiliation(s)
- Antonio E Pérez
- Department of Epidemiology, Institute Pedro Kourí, Autopista Novia del Mediodía Km, 6 1/2 Municipio La Lisa, Ciudad Habana, 17100, Cuba.
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Barichello T, Dos Santos I, Savi GD, Simões LR, Generoso JS, Comim CM, Sachs D, Teixeira AL, Quevedo J. Depressive-like-behavior and proinflamatory interleukine levels in the brain of rats submitted to pneumococcal meningitis. Brain Res Bull 2010; 82:243-6. [PMID: 20450961 DOI: 10.1016/j.brainresbull.2010.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/20/2010] [Accepted: 04/27/2010] [Indexed: 11/19/2022]
Abstract
Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensorymotor deficits, seizures, and impairments of learning and memory. The presence of proliferating bacteria within the subarachnoid and ventricular space compartments triggers an intense inflammatory host response. Proinflammatory mediators released in the process include tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-6, and all of which have been shown to contribute to the development of brain injury in bacterial meningitis. The animals underwent a magna cistern tap receiving either 10muL sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration 5x10(9)cfu/mL. Ten days after induction we evaluated depressive-like behavior by using the forced swimming test and verified the levels of the TNF-alpha, IL-1beta, IL-6 and CINC-1 in the brain of rats induced to pneumococcal meningitis. In the forced swimming test we observed a significant increase in the immobility time in the meningitis group compared to the sham group (p<0.05). The TNFlevels were found increased in the prefrontal cortex (p<0.05, F=4.921), but not hippocampus. The IL-6, CINC-1 and IL-1beta levels presented no alteration in both prefrontal cortex and hippocampus 10 days after meningitis induction by S. pneumoniae. These findings suggest that the meningitis model could be a good research tool for the study of the biological mechanisms involved in the behavioral alterations secondary to pneumococcal meningitis.
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Affiliation(s)
- Tatiana Barichello
- Laboratory of Experimental Microbiology and National Institute for Translational Medicine (INCT-TM), Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, 88806-000 Criciúma, SC, Brazil.
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TNF-α, IL-1β, IL-6, and cinc-1 levels in rat brain after meningitis induced by Streptococcus pneumoniae. J Neuroimmunol 2010; 221:42-5. [DOI: 10.1016/j.jneuroim.2010.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/17/2022]
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Ward MA, Greenwood TM, Kumar DR, Mazza JJ, Yale SH. Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. Clin Med Res 2010; 8:13-7. [PMID: 20305144 PMCID: PMC2842389 DOI: 10.3121/cmr.2010.862] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michael A. Ward
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tonia M. Greenwood
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David R. Kumar
- Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield Wisconsin
| | - Joseph J. Mazza
- Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield Wisconsin
| | - Steven H. Yale
- Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield Wisconsin
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Laguna-Del-Estal P, García-Madero R, Gil-Navarro M, García-Zubiri C, Agud-Fernández M. Meningitis aguda bacteriana en ancianos. Rev Clin Esp 2010; 210:57-64. [DOI: 10.1016/j.rce.2009.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/05/2009] [Accepted: 07/11/2009] [Indexed: 11/26/2022]
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Barichello T, dos Santos I, Savi GD, Florentino AF, Silvestre C, Comim CM, Feier G, Sachs D, Teixeira MM, Teixeira AL, Quevedo J. Tumor necrosis factor alpha (TNF-alpha) levels in the brain and cerebrospinal fluid after meningitis induced by Streptococcus pneumoniae. Neurosci Lett 2009; 467:217-9. [PMID: 19835931 DOI: 10.1016/j.neulet.2009.10.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 10/06/2009] [Accepted: 10/09/2009] [Indexed: 01/06/2023]
Abstract
Bacterial meningitis due to Streptococcus pneumoniae is associated with a significant mortality rate and persisting neurologic sequelae including sensory-motor deficits, seizures, and impairments of learning and memory. The presence of proliferating bacteria within the subarachnoid and ventricular space compartments triggers an intense inflammatory host response at killing the invading microorganism. Proinflammatory mediators released in the process include tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-6. TNF-alpha have several effects, including cytotoxicity, antiviral activity, transcription factor activation, and immune response regulation. Thus, the aim of this study was to verify the levels of the TNF-alpha after pneumococcal meningitis in male Wistar rats. The animals underwent a magna cistern tap receiving either 10 microL sterile saline as a placebo or an equivalent volume of a S. pneumoniae suspension at the concentration 5 x 10(9)cfu/mL. The animals were killed at 0, 6, 12, 24, 48 and 96 h after induction. The brain was removed and hippocampus, cortex, prefrontal and cerebrospinal fluid (CSF) were isolated and used for the determination of TNF-alpha levels. We found an increase in TNF-alpha levels at 6h after induction of the meningitis in the hippocampus (p<0.01), frontal cortex (p<0.05), and cerebrospinal fluid (p<0.001).There was no alteration in the cortex. Our data suggest that TNF-alpha is involved in the pathophysiology of the pneumococcal meningitis and could be investigated as a putative biomarker for brain damage in the first hours.
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Affiliation(s)
- Tatiana Barichello
- Laboratório de Fisiopatologia Experimental and Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.
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Honda H, Warren DK. Central Nervous System Infections: Meningitis and Brain Abscess. Infect Dis Clin North Am 2009; 23:609-23. [DOI: 10.1016/j.idc.2009.04.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lucht F. [Sensitivity and specificity of clinical signs in adults]. Med Mal Infect 2009; 39:445-51. [PMID: 19632074 DOI: 10.1016/j.medmal.2009.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 11/30/2022]
Abstract
Clinical diagnosis of acute bacterial meningitis may be delayed, either because off lack of sensitivity of clinical signs, or because of a poor vital prognosis; but over diagnosing is also frequent, leading to useless, expensive, and potentially dangerous hospitalizations. We conducted a comprehensive review of English and French literature from 1997 to 2007 by searching MEDLINE to review the accuracy of clinical examination for the diagnosis of meningitis. Additional references were identified by reviewing reference lists of articles back to 1993. We used the keywords "meningitis", "meningitis and clinical features", "cerebrospinal fluid (CSF) pleocytosis", "headache and fever", "Kernig sign", "Brudzinski sign", and "neck stiffness". We excluded nosocomial meningitis. Sensitivity for clinical signs such as headache, vomiting, or fever was low, generally less than 30%, neck stiffness could reach 45%, but the absence of two signs among fever, headache, neck stiffness, and altered mental status eliminated meningitis with a negative predictive value of 95%. Given the seriousness of bacterial meningitis, clinicians perform lumbar puncture (or brain imaging) too often, especially in high-risk patients. Further prospective clinical research is needed to improve the accuracy of bacterial meningitis clinical diagnosis.
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Affiliation(s)
- F Lucht
- Service des maladies infectieuses et tropicales, hôpital Nord, 42055 Saint-Etienne cedex 02, France.
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Hsu CL, Chang CH, Wong KN, Chen KY, Yu CJ, Yang PC. Management of severe community-acquired septic meningitis in adults: from emergency department to intensive care unit. J Formos Med Assoc 2009; 108:112-8. [PMID: 19251546 DOI: 10.1016/s0929-6646(09)60041-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE To study the clinical features, diagnostic processes, timing of antibiotic administration and outcomes of patients with severe community-acquired septic meningitis at an emergency department (ED), who required intensive care unit (ICU) admission. METHODS From January 1993 to December 2005, the medical records of patients admitted to the ICU with a diagnosis of community-acquired septic meningitis were reviewed. The clinical characteristics, including causative pathogens, treatment course, and outcomes were collected and analyzed. RESULTS A total of 40 patients were included, with an overall in-hospital mortality rate of 77.5%. The most common pathogen was Klebsiella pneumoniae (n=20, 50%), followed by Streptococcus pneumoniae (n=6, 15%), and Cryptococcus neoformans (n=5, 12.5%). There was a mean duration of 8.9 hours between ED arrival and initiation of antibiotic therapy. Effective antibiotics were administered for a mean period of 23.8 hours after arrival. Time delay from ED arrival to ICU admission was correlated with time delay of effective antibiotics administration, head computed tomography, and cerebrospinal fluid study (r=0.32, 0.47, and 0.53, respectively; p=0.05, 0.006, and 0.001, respectively). Earlier ICU admission was demonstrated in survivors as compared with those who died (11.1 vs. 38.0 hours, p=0.01). CONCLUSION Severe septic meningitis remains a disease with high mortality and morbidity. Expeditious diagnostic processes with early appropriate antibiotic treatment and ICU admission at the ED are important in improving the quality of care and patient outcome.
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Affiliation(s)
- Chia-Lin Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Cabellos C, Verdaguer R, Olmo M, Fernández-Sabé N, Cisnal M, Ariza J, Gudiol F, Viladrich PF. Community-acquired bacterial meningitis in elderly patients: experience over 30 years. Medicine (Baltimore) 2009; 88:115-119. [PMID: 19282702 DOI: 10.1097/md.0b013e31819d50ef] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clinical characteristics, etiologies, evolution, and prognostic factors of community-acquired bacterial meningitis in elderly patients are not well known. To improve this knowledge, all episodes of community-acquired bacterial meningitis were prospectively recorded and cases occurring in patients >or=65 years old were selected. During the period 1977-2006, 675 episodes in adults (aged >or=18 yr) were recorded, with 185 (27%) in patients aged >or=65 years old; 76 were male and 109 were female, with a mean age of 73 +/- 6 years (range, 65-93 yr). Causative microorganisms were Streptococcus pneumoniae 74, Neisseria meningitidis 49, Listeria monocytogenes 17, other streptococcal 9, Escherichia coli 6, Haemophilus influenzae 4, Klebsiella pneumoniae and Staphylococcus aureus 2 each, Capnocytophaga canimorsus and Enterococcus faecalis 1 each, and unknown in 20. On admission 91% had had fever, 32% were in a coma (Glasgow Coma Scale <or=8), 9% presented with seizures, and 8% with shock. Thirty patients (16%) presented with seizures during therapy. Mortality was 58/185 (31%). Compared with patients aged 18-65 years, there were significant differences among older patients (aged >or=65 yr), who showed a higher frequency of diabetes and malignancy as underlying disease; pneumonia, otitis, and pericranial fistula as predisposing factors; and S. pneumoniae and L. monocytogenes as etiology. There were also differences in clinical presentation, complications, sequelae, and mortality. Factors independently related with mortality were age, pneumonia as a predisposing factor, coma on admission, and heart failure and seizures after therapy. Dexamethasone therapy was a protective factor. In conclusion, bacterial meningitis in elderly patients is associated with greater diagnostic difficulties and neurologic severity and more complications, as well as with increased mortality. Antiseizure prophylaxis might be useful in these patients.
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Affiliation(s)
- Carmen Cabellos
- From the Infectious Diseases Service (CC, MO, NFS, XA, FG, PFV) and Microbiology Service (RV, MC). IDIBELL. Hospital Universitari de Bellvitge, Barcelona, Spain
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Lee BY, Ercius AK, Smith KJ. A predictive model of the economic effects of an influenza vaccine adjuvant for the older adult (age 65 and over) population. Vaccine 2009; 27:2251-7. [PMID: 19428839 DOI: 10.1016/j.vaccine.2009.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 11/17/2022]
Abstract
Immunosenescence decreases influenza vaccine efficacy in older adults (age 65 and over). Strategies such as vaccine adjuvants are being developed to overcome immunosenescence. Our computer simulation model represented the decision to give an older adult either standard influenza vaccine or adjuvanted influenza vaccine and found the adjuvanted vaccine to be dominant in many scenarios, resulting in lowered cost and greater effectiveness. An adjuvanted vaccine that is 100% effective in overcoming immunosenescence remained dominant until its cost exceeded the standard vaccine cost by $65. In a single influenza season, the adjuvant would prevent 496,533 influenza cases, 171,981 hospitalizations, and 70,429 deaths.
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Affiliation(s)
- Bruce Y Lee
- Section of Decision Sciences and Clinical Systems Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
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