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Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review. J Clin Med 2023; 12:jcm12030849. [PMID: 36769498 PMCID: PMC9917955 DOI: 10.3390/jcm12030849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Invasive meningococcal disease (IMD) remains a significant health concern due to its unpredictable nature and its rapid progression. Even if occurrence of IMD is strictly monitored by a national surveillance network, no information on long-term sequelae is reported, making it difficult to assess the entire clinical burden of IMD in France. The aim of this scoping review was to analyze the epidemiology and the clinical burden of IMD in France by reporting the main epidemiological parameters, and by describing the clinical consequences and the care pathway of patients. The process of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to the Scoping Reviews guidelines. In France, the incidence of IMD cases has been fluctuating over time, characterized by an overall downward trend linked to a decrease in Sg B cases and the introduction of mandatory vaccination against Sg C. Sg W cases increased in recent years (from 5% to 21% in 2019). The case fatality rate remained constant (6-12.9%). The most frequently reported sequelae were severe neurological disorder, epilepsy, and anxiety. However, data on sequelae and care pathways were scarce. Further research should concentrate on providing robust identification of sequelae and the subsequent impact on quality of life, as well as on the organization of optimal care and support for patients and their families.
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Zhang Z, Wen H, Wang H, Zhang P, Li J, Liang Y, Liu Y, Sun L, Xie S. A Case of Meningitis in an Infant Due to Hypervirulent Klebsiella pneumoniae Transmission Within a Family. Infect Drug Resist 2022; 15:4927-4933. [PMID: 36060238 PMCID: PMC9439645 DOI: 10.2147/idr.s376055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP), an emerging pathotype derived from K. pneumoniae, frequently causes invasive infections of multiple organs and is associated with both high disability and fatality rates. In this study, a case of meningitis in a young infant caused by hvKP is presented. Cytological and biochemical examinations of the cerebrospinal fluid (CSF) revealed purulent meningitis, a diagnosis that was confirmed by a positive CSF culture result. The pathogen was identified as hvKP through analysis of positive virulence-associated genes. Meanwhile, hvKP was also isolated from stool samples of both the infant and her father. Antimicrobial susceptibility, capsular typing, and multilocus sequence typing (MLST) of three isolates from the infant's CSF and stool and her father's stool samples were analyzed. The three K. pneumoniae isolates were susceptible to all antibiotics except ampicillin and were identified as capsular serotype K2 and sequence type 86. These genetic relatedness analyses indicated that the strain isolated from the infant's CSF might have originated from her father's stool via familial transmission. This case is the first report of meningitis in an infant due to hvKP transmitted within a family.
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Affiliation(s)
- Zongwei Zhang
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Hainan Wen
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Hui Wang
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Pan Zhang
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Jing Li
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Yueyi Liang
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Yanchao Liu
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Lihong Sun
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
| | - Shoujun Xie
- Department of Clinical Laboratory, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China
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Jbari S, Lahmini W, Boussaa S, Bourrous M. Impact of Covid-19 pandemic on pediatric meningitis incidence in central Morocco. SCIENTIFIC AFRICAN 2022; 16:e01213. [PMID: 36248769 PMCID: PMC9548638 DOI: 10.1016/j.sciaf.2022.e01213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/18/2022] [Accepted: 05/01/2022] [Indexed: 01/17/2023] Open
Abstract
Bacterial meningitis is a diagnostic, therapeutic, and prophylactic emergency, particularly for children. In Morocco, meningitis remains a major public health challenge with lethality between 10% and 12% of cases. Our objective is to determine the impact of COVID-19 pandemic on the incidence of pediatric meningitis in central Morocco. A retrospective epidemiological study was carried out in the Department of Pediatric Emergencies of the Mother and Child Hospital of Marrakech in Morocco. Data were collected from patient files of Meningitis cases reported during the confinement period in March, April, and May of 2019 and 2020 respectively. Then, data were analyzed using SPSS software. The results showed a notification of 72 cases of suspected meningitis between March 2019 and March 2020 with dominance of boys (up to 70%) and age range of 1 month to 2 years (up to 34%). We noted a decrease in the number of patients hospitalized for suspected meningitis during COVID-19 pandemic. The final diagnosis of suspected meningitis was confirmed for 20% of the cases during the containment period against only 2.38% before the pandemic. This difference was statistically significant (P<0.05). Our investigations confirm the effect of the COVID-19 pandemic on the incidence of bacterial meningitis of children in the study area, more investigations are needed to generalize and explain these results in Morocco.
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Affiliation(s)
- Siham Jbari
- Infectious Disease Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University Marrakech, 40000, Morocco,Childhood Health and Development Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University Marrakech, 40000, Morocco
| | - Widad Lahmini
- Childhood Health and Development Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University Marrakech, 40000, Morocco
| | - Samia Boussaa
- ISPITS-Higher Institute of Nursing and Health Techniques, Ministry of Health and Social Protection, Rabat, 10000, Morocco,Corresponding author
| | - Mounir Bourrous
- Childhood Health and Development Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University Marrakech, 40000, Morocco
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Pilmis B, de Ponfilly GP, Farfour E, Ranc AG, Fihman V, Bille E, Dortet L, Degand N, Morand P, Potron A, Mizrahi A, Laurent F, Le Brun C, Guillard T, Héry-Arnaud G, Piau C, Barraud O, Ruffier d'Epenoux L, Zahar JR, Le Monnier A. Epidemiology and clinical characteristics of Klebsiella spp. meningitis in France. Infect Dis Now 2021; 52:82-86. [PMID: 34091093 DOI: 10.1016/j.idnow.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the epidemiology of Klebsiella spp. meningitis in France with respect to clinical and bacteriological data. METHODS We performed a four-year multicenter, retrospective, observational study. The primary objective was to provide a clinical description of patients with Klebsiella spp. meningitis. Secondary objectives were to compare community-acquired meningitis and healthcare-associated meningitis and to analyze factors associated with mortality. RESULTS We enrolled 131 patients with Klebsiella spp. meningitis. Eighty-two (62.6%) infections were reported following neurosurgery. Twenty-eight strains (21.4%) were resistant to third-generation cephalosporins (3GC). The median [IQR] cellularity was 980/mm3 [116-5,550], the median protein level was 5.67 [1.62-9] g/L and the median CSF glucose level was 2.5 [0-3.4] mmol/L. The in-hospital mortality rate was 23.6%. Community-acquired meningitis isolates were more frequently susceptible to 3GC than isolates from healthcare-associated meningitis (89.2% versus 72%; p=0.04). Comorbidities reported for patients with community-acquired meningitis were mainly diabetes mellitus and liver cirrhosis. In multivariate analysis, focal neurological disorder at the time of diagnosis was the only factor associated with in-hospital mortality (p=0.01). CONCLUSIONS Purulent meningitis caused by Klebsiella spp. needs to be considered in patients with community-acquired meningitis and pre-existing conditions, as well as in case of meningitis following neurosurgical procedures.
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Affiliation(s)
- B Pilmis
- Équipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France. Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France; Service de Maladies infectieuses et Tropicales, Hôpital Necker Enfants Malades, Paris, France.
| | - G Péan de Ponfilly
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France. Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France; Laboratoire de Bactériologie, Département des Agents infectieux, CHU Saint Louis-Lariboisière-Fernand Widal, APHP, 75010 Paris, France
| | - E Farfour
- Service de Biologie Clinique, Hôpital Foch, 92150 Suresnes, France
| | - A-G Ranc
- Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, Lyon, France
| | - V Fihman
- Unité de Bactériologie, Groupe Hospitalier Henri Mondor, 94010 Créteil, France
| | - E Bille
- Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, 75015 Paris, France
| | - L Dortet
- Service de Bactériologie-Hygiène, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - N Degand
- Laboratoire de Bactériologie, Hôpital Larchet, CHU Nice, 06202 Nice, France
| | - P Morand
- Université de Paris, Faculté de Médecine Paris Centre; Groupe hospitalier APHP-CUP, Service de Bactériologie, 75014 Paris, France
| | - A Potron
- Centre National de Référence de la résistance aux antibiotiques, Centre Hospitalier Universitaire de Besançon, UMR6249 CNRS Chrono-Environnement, Université de Franche-Comté, Besançon, France
| | - A Mizrahi
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France. Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France; Laboratoire de Microbiologie et Plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Laurent
- Institut des Agents Infectieux (IAI), Hospices Civils de Lyon, Lyon, France
| | - C Le Brun
- Service de Bactériologie-Virologie-Hygiène, Hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - T Guillard
- Université de Reims-Champagne-Ardenne, Inserm UMR-S 1250 P3Cell, SFR CAP-Santé ; Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière-Parasitologie-Mycologie, Hôpital Robert Debré, CHU Reims, 51000 Reims, France
| | - G Héry-Arnaud
- Université de Brest, Inserm, UMR 1078, Unité de Bactériologie, CHRU de Brest, F-29200 Brest, France
| | - C Piau
- Service de Bactériologie-Hygiène hospitalière, CHU de Rennes, 35033 Rennes, France
| | - O Barraud
- Service de bactériologie, virologie, hygiène, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - L Ruffier d'Epenoux
- Service de Bactériologie-Hygiène hospitalière, CHU de Nantes, Institut de Biologie, 9 quai Moncousu 44093, Cedex 1, Nantes, France
| | - J-R Zahar
- Hygiène Hospitalière Et Prévention du Risque Infectieux, CHU Avicenne, AP-HP, 125 rue de Stalingrad, 93000, Bobigny, France
| | - A Le Monnier
- Institut Micalis UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Châtenay Malabry, France. Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France; Laboratoire de Bactériologie, Département des Agents infectieux, CHU Saint Louis-Lariboisière-Fernand Widal, APHP, 75010 Paris, France
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Abdelrahim NA, Fadl-Elmula IM, Ali HM. Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules. BMC Pediatr 2019; 19:319. [PMID: 31492124 PMCID: PMC6729048 DOI: 10.1186/s12887-019-1684-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudan falls in the meningitis belt where most global cases of bacterial meningitis are reported. Highly accurate decision support tools have been developed by international specialized societies to guide the diagnosis and limit unnecessary hospital admissions and prolonged antibiotic use that have been frequently reported from countries around the world. The goals of this study are to critically evaluate the clinical decision of bacterial meningitis in children in Sudan using clinical prediction rules and to identify the current bacterial aetiology. METHODS This cross-sectional hospital-based study was conducted in October to July of 2010 in a major referral pediatric hospital in Khartoum, Sudan. Febrile children age 1 day to 15 years who were provisionally diagnosed as having meningitis on admission were included (n = 503). Cerebrospinal fluid (CSF) specimens were obtained from all patients while clinical and demographic data were available for only 404. Conventional laboratory investigations were performed. The clinical decision was evaluated by the International Classification of Diseases-Clinical Modification code 320.9 and the Bacterial Meningitis Score. Ethical clearance and permissions were obtained. RESULTS Out of 503 provisionally diagnosed bacterial meningitis patients, the final clinical confirmation was assigned to 55.9%. When codes were applied; 5.7% (23/404) with CSF pleocytosis were re-classified as High Risk for bacterial meningitis and 1.5% (6/404) with confirmed bacterial aetiology as Proven Bacterial Meningitis. Neisseria meningitidis was identified in 0.7% (3/404) and Streptococcus pneumoniae in another 0.7%. Typical laboratory findings (i.e. CSF pleocytosis and/or low glucose and high protein concentrations, Gram positive or Gram negative diplococcic, positive bacterial culture) were seen in 5 (83%). Clinically, patients showed fever, seizures, chills, headache, vomiting, stiff neck and bulging fontanelle. All confirmed cases were less than 5 years old and were admitted in summer. All patients were prescribed with antibiotics; they were all recovered and discharged. CONCLUSIONS Bacterial meningitis is over-diagnosed in hospitals in Khartoum therefore clinical prediction rules must be adopted and applied to guide the clinical decision. The sole bacterial aetiology in this selected group of Sudanese children remain N. meningitidis and S. pneumoniae, but with significant decrease in prevalence. Some cases showed atypical clinical and laboratory findings.
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Affiliation(s)
- Nada Abdelghani Abdelrahim
- Department of Pharmaceutics-Medical Microbiology, Faculty of Pharmacy, Nile University, Hai El-Gamaa, Al-Ailafoon Road, East Manshya Bridge, P.O. Box 11111, Khartoum, Sudan.
| | | | - Hassan Mohammed Ali
- Department of Clinical Pharmacology, Faculty of Pharmacy, National University-Sudan, Khartoum, Sudan
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Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Arch Pediatr 2019; 26:133-137. [DOI: 10.1016/j.arcped.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/07/2019] [Accepted: 02/09/2019] [Indexed: 11/19/2022]
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7
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Carrie C, Walewski V, Levy C, Alexandre C, Baleine J, Charreton C, Coche-Monier B, Caeymaex L, Lageix F, Lorrot M, Klosowski S, Hess L, Zafer O, Gaudelus J, Pinquier D, Carbonnelle E, Cohen R, de Pontual L. Klebsiella pneumoniae and Klebsiella oxytoca meningitis in infants. Epidemiological and clinical features. Arch Pediatr 2018; 26:12-15. [PMID: 30558858 DOI: 10.1016/j.arcped.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/15/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The incidence of meningitis caused by Klebsiella pneumoniae (Kp) and Klebsiella oxytoca (Ko) in high-income countries is unknown, and no series have been published to date. METHODS We conducted a nationwide multicenter observational study in France between 2006 and 2016. All children from the French national registry for paediatric bacterial meningitis under the age of 1 year and hospitalized for Kp or Ko meningitis were included. Virulence factors of four Klebsiella spp. strains were explored by whole genome sequencing. RESULTS Of 1859 cases of meningitis in children under the age of 1 year, 13 cases (0.7%) of Klebsiella spp. meningitis (nine for Kp meningitis and four for Ko meningitis) were registered in the French national registry. Three of the patients died and 50% of the survivors had developmental delays. CONCLUSIONS Prematurity, low birth weight, and congenital anomalies of the urinary tract appear to be risk factors for Klebsiella spp. meningitis as well as virulence factors of the strain.
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Affiliation(s)
- C Carrie
- Service de pédiatrie, hôpitaux universitaires Paris Seine-Saint-Denis (HUPSSD) site Jean Verdier, université Paris XIII, AP-HP, avenue du 14 Juillet, 93140 Bondy, France
| | - V Walewski
- Service de bactériologie-virologie, hygiène, hôpitaux universitaires de Paris-Seine-Denis (HUPSSD), laboratoire de microbiologie hôpital Avicenne, hôpitaux universitaires de Paris-Seine-Denis (HUPSSD), 125, rue de Stalingrad, 93000 Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, 75018 Paris, France
| | - C Levy
- IMRB GRC GEMINI, ACTIV et université Paris-Est, 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Service de médecine néonatale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Groupe de pathologie infectieuse pédiatrique, 57, avenue de la Californie, 06200 Nice, France; IMRB-GRC GEMINI, université Paris-Est, 40, avenue de Verdun, 94000 Créteil, France
| | - C Alexandre
- Service de néonatologie et réanimation néonatale, 14033 Caen, France
| | - J Baleine
- Service de pédiatrie néonatale et réanimations, CHU Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France
| | - C Charreton
- Service de néonatologie et réanimation néonatale, avenue des Tamaris, 13616 Aix-en-Provence, France
| | - B Coche-Monier
- Service de pédiatrie, centre hospitalier Simone Veil, 14, rue de Saint-Prix, 95600 Eaubonne, France
| | - L Caeymaex
- Service de médecine néonatale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; IMRB-GRC GEMINI, université Paris-Est, 40, avenue de Verdun, 94000 Créteil, France
| | - F Lageix
- Service de pédiatrie, hôpitaux universitaires Paris Seine-Saint-Denis (HUPSSD) site Jean Verdier, université Paris XIII, AP-HP, avenue du 14 Juillet, 93140 Bondy, France
| | - M Lorrot
- Service de pédiatrie, hôpital Armand-Trousseau, AP-HP, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - S Klosowski
- Service de pédiatrie, 99, route de la Bassée, 62300 Lens, France
| | - L Hess
- Service d'urgence et de réanimation pédiatrique, hôpital, 59, boulevard Pinel, 69500 Bron, France
| | - O Zafer
- Service de pédiatrie, boulevard Laennec, 60100 Creil, France
| | - J Gaudelus
- Service de pédiatrie, hôpitaux universitaires Paris Seine-Saint-Denis (HUPSSD) site Jean Verdier, université Paris XIII, AP-HP, avenue du 14 Juillet, 93140 Bondy, France; Groupe de pathologie infectieuse pédiatrique, 57, avenue de la Californie, 06200 Nice, France
| | - D Pinquier
- Groupe de pathologie infectieuse pédiatrique, 57, avenue de la Californie, 06200 Nice, France; Pediatrie néonatale et réanimation, Pavillon Mère-Enfant, hôpital Charles Nicolle, CHU de Rouen, université de Normandie, 76000 Rouen, France
| | - E Carbonnelle
- Service de bactériologie-virologie, hygiène, hôpitaux universitaires de Paris-Seine-Denis (HUPSSD), laboratoire de microbiologie hôpital Avicenne, hôpitaux universitaires de Paris-Seine-Denis (HUPSSD), 125, rue de Stalingrad, 93000 Bobigny, France; Université Paris Nord, IAME, UMR 1137, Sorbonne Paris Cité, 75018 Paris, France
| | - R Cohen
- IMRB GRC GEMINI, ACTIV et université Paris-Est, 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Service de médecine néonatale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Groupe de pathologie infectieuse pédiatrique, 57, avenue de la Californie, 06200 Nice, France; IMRB-GRC GEMINI, université Paris-Est, 40, avenue de Verdun, 94000 Créteil, France
| | - L de Pontual
- Service de pédiatrie, hôpitaux universitaires Paris Seine-Saint-Denis (HUPSSD) site Jean Verdier, université Paris XIII, AP-HP, avenue du 14 Juillet, 93140 Bondy, France; Groupe de pathologie infectieuse pédiatrique, 57, avenue de la Californie, 06200 Nice, France.
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Levy C, Vie le Sage F, Varon E, Chalumeau M, Grimprel E, Cohen R. Pediatric Ambulatory and Hospital Networks for Surveillance and Clinical Epidemiology of Community-Acquired Infections. J Pediatr 2018; 194:269-270.e2. [PMID: 29637893 DOI: 10.1016/j.jpeds.2017.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Corinne Levy
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - François Vie le Sage
- GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hospital Georges-Pompidou, Paris, France
| | - Martin Chalumeau
- GPIP, Pediatric Infectious Disease Group, France; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM U1153), Paris Descartes University, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emmanuel Grimprel
- GPIP, Pediatric Infectious Disease Group, France; Department of General Pediatrics, Hospital Trousseau, AP-HP, University Pierre et Marie Curie, Paris, France
| | - Robert Cohen
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France; Unité Court Séjour, Petits Nourrissons, Neonatology Department, Centre Hospitalier Intercommunal de Créteil, France
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Internetbasierte Erfassung und Bearbeitung von Forschungsdaten zur Kindergesundheit. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0453-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Guedj R, Chappuy H, Titomanlio L, De Pontual L, Biscardi S, Nissack-Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Denis J, Levy C, Cohen R, Loschi S, Leger PL, Carbajal R. Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture? Ann Emerg Med 2017; 70:52-62.e6. [DOI: 10.1016/j.annemergmed.2016.11.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 10/18/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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Cohen R, Biscardi S, Levy C. The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014. Hum Vaccin Immunother 2016; 12:277-84. [PMID: 26905678 DOI: 10.1080/21645515.2015.1116654] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In 2003, France was the first European country to recommend 7-valent pneumococcal conjugate vaccine (PCV7) for a large proportion of healthy children. With complicated recommendations, the vaccine coverage during the first 4 y of implementation was low, then progressively increased to reach 90% in 2008. The aim of this review was to describe the particular impact of PCVs in a country where the vaccine coverage was initially suboptimal. After PCV7 implementation, the PCV7 serotypes nearly disappeared among pneumococci isolated from meningitis (-73%), other invasive pneumococcal disease (IPD; -90%) and pneumococcal carriage (-97%). Consequently, the rates of penicillin-resistant strains declined. However, because of important serotype replacement, the global effect on the incidence of meningitis (-31%) or other IPD (-14%) was modest and observed only in young children < 2 y old. After PCV13 transition, with immediate high vaccine coverage, the vaccine had an important impact on all pneumococcal disease: reduction of -20% for pneumococcal meningitis, -36% for non-meningitis IPD, -32% for community acquired pneumonia and -15% for S. pneumoniae carriage. These findings underline the complexity of pneumococcal epidemiology and the importance of high and fast vaccination coverage to obtain the optimal effect of PCVs.
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Affiliation(s)
- Robert Cohen
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,d Unité Court Séjour; Petits Nourrissons ; Service de Néonatologie; Centre Hospitalier Intercommunal de Créteil ; France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
| | - Sandra Biscardi
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France.,f Service des urgences pédiatriques ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France
| | - Corinne Levy
- a Université Paris Est ; IMRB- GRC GEMINI ; Créteil , France.,b ACTIV; Association Clinique et Thérapeutique Infantile du Val de Marne ; Saint-Maur des Fossés , France.,c Clinical Research Center (CRC) ; Centre Hospitalier Intercommunal de Créteil ; Créteil , France.,e GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie) ; Paris , France
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Secher T, Brehin C, Oswald E. Early settlers: which E. coli strains do you not want at birth? Am J Physiol Gastrointest Liver Physiol 2016; 311:G123-9. [PMID: 27288422 DOI: 10.1152/ajpgi.00091.2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/21/2016] [Indexed: 01/31/2023]
Abstract
The intestinal microbiota exerts vital biological processes throughout the human lifetime, and imbalances in its composition have been implicated in both health and disease status. Upon birth, the neonatal gut moves from a barely sterile to a massively colonized environment. The development of the intestinal microbiota during the first year of life is characterized by rapid and important changes in microbial composition, diversity, and magnitude. The pioneer bacteria colonizing the postnatal intestinal tract profoundly contribute to the establishment of the host-microbe symbiosis, which is essential for health throughout life. Escherichia coli is one of the first colonizers of the gut after birth. E. coli is a versatile population including harmless commensal, probiotic strains as well as frequently deadly pathogens. The prevalence of the specific phylogenetic B2 group, which encompasses both commensal and extra- or intraintestinal pathogenic E. coli strains, is increasing among E. coli strains colonizing infants quickly after birth. Fifty percent of the B2 group strains carry in their genome the pks gene cluster encoding the synthesis of a nonribosomal peptide-polyketide hybrid genotoxin named colibactin. In this review, we summarize both clinical and experimental evidence associating the recently emerging neonatal B2 E. coli population with several pathology and discuss how the expression of colibactin by both normal inhabitants of intestinal microflora and virulent strains may darken the borderline between commensalism and pathogenicity.
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Affiliation(s)
- Thomas Secher
- UMR1220, Institute de Recherche en Santé Digestive, INSERM-INRA-UPS-ENVT, Toulouse, France
| | - Camille Brehin
- UMR1220, Institute de Recherche en Santé Digestive, INSERM-INRA-UPS-ENVT, Toulouse, France; CHU Toulouse, Hôpital Purpan, Service de Pédiatrie, Toulouse, France; and
| | - Eric Oswald
- UMR1220, Institute de Recherche en Santé Digestive, INSERM-INRA-UPS-ENVT, Toulouse, France; CHU Toulouse, Hôpital Purpan, Service de Bactériologie-Hygiène, Toulouse, France
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Guedj R, Chappuy H, Titomanlio L, Trieu TV, Biscardi S, Nissack-Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Villemeur TBD, Levy C, Cohen R, Armengaud JB, Carbajal R. Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross-sectional, Observational Study. Acad Emerg Med 2015; 22:1290-7. [PMID: 26468690 DOI: 10.1111/acem.12798] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture (LP) in children under 12 months of age with a first simple febrile seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple febrile seizure. METHODS This multicenter retrospective study was conducted in seven pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple febrile seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow-up were searched for in a national bacterial meningitis database. RESULTS From a total of 1,183,487 visits in the seven pediatric EDs, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple febrile seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow-up were registered in the national database as having bacterial meningitis. CONCLUSIONS Among children between 6 and 11 months of age with a first simple febrile seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to widely homogenized management practices.
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Affiliation(s)
- Romain Guedj
- Pediatric Emergency Department; Assistance Publique des Hôpitaux de Paris; Armand Trousseau Hospital; Pierre et Marie Curie University; Paris France
- INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemilogy Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy, Paris Descartes University; Paris France
| | - Hélène Chappuy
- Pediatric Emergency Department; Assistance Publique des Hôpitaux de Paris; Armand Trousseau Hospital; Pierre et Marie Curie University; Paris France
| | - Luigi Titomanlio
- pediatric emergency department; Robert Debre Hospital; Paris France
| | - Thanh-Van Trieu
- Pediatric Emergency Department; Jean Verdier Hospital; Bondy France
| | - Sandra Biscardi
- Pediatric Emergency Department; Centre Intercommunal de Creteil; Creteil France
| | | | | | - Oussama Charara
- Pediatric Department; Versailles Hospital; Le Chesnay France
| | - François Angoulvant
- Pediatric Emergency Department; Necker-Enfants Malades Hospital; Paris France
| | - Thierry Billette De Villemeur
- Pediatric Neurology department; Assistance Publique des Hôpitaux de Paris; Armand Trousseau Hospital; Pierre et Marie Curie University; Paris France
| | - Corinne Levy
- Clinical Research Center; Centre Intercommunal de Creteil; Creteil France
- ACTIV; Pediatric Clinical and Therapeutical Association of the Val de Marne; Saint-Maur des Fossés France
| | - Robert Cohen
- Clinical Research Center; Centre Intercommunal de Creteil; Creteil France
- ACTIV; Pediatric Clinical and Therapeutical Association of the Val de Marne; Saint-Maur des Fossés France
| | - Jean Baptiste Armengaud
- Pediatric Emergency Department; Assistance Publique des Hôpitaux de Paris; Armand Trousseau Hospital; Pierre et Marie Curie University; Paris France
| | - Ricardo Carbajal
- Pediatric Emergency Department; Assistance Publique des Hôpitaux de Paris; Armand Trousseau Hospital; Pierre et Marie Curie University; Paris France
- INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemilogy Research Team (Epopé); Center for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in pregnancy, Paris Descartes University; Paris France
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Basmaci R, Bonacorsi S, Bidet P, Biran V, Aujard Y, Bingen E, Béchet S, Cohen R, Levy C. Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France. Clin Infect Dis 2015; 61:779-86. [PMID: 25944342 DOI: 10.1093/cid/civ367] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We aimed to describe features of Escherichia coli meningitis in a large population of children and the molecular characteristics of the involved strains to determine factors associated with severe disease or death. METHODS Between 2001 and 2013, a prospective national survey collected data for 325 children hospitalized with E. coli meningitis. The national reference center genetically characterized 141 isolates. RESULTS Among the 325 cases, 65.2% were term, 22.4% late preterm, and 12.5% very/extremely preterm infants. Escherichia coli meningitis was 7-fold more frequent in preterm than term infants. Median age at diagnosis was 14 days; 71.1% of infants were neonates, with 2 peaks of infection at age 0-3 days (mostly preterm neonates) and 11-15 days (mostly term neonates); 8.9% were >89 days old. In total, 51.1% patients were considered to have severe disease, and 9.2% died. B2.1 phylogenetic subgroup (56%) and O1 serogroup (27.7%) were the most frequently identified. On multivariate analysis, death was associated with preterm birth (odds ratio [OR], 3.3 [95% confidence interval {CI}, 1.3-8.4], P = .015 for late preterm infants; OR, 7.3 [95% CI, 2.7-20.9], P < .001 for very/extremely preterm infants) and cerebrospinal fluid (CSF) to blood glucose ratio <0.10 (OR, 15.3 [95% CI, 1.8-128.3], P = .012). Death was associated with uncommon O serogroup strains (P = .014) and severe disease with O7 serogroup (P = .034) and PapGII adhesin (OR, 2.3 [95% CI, 1.2-4.5], P = .015). CONCLUSIONS In this large study of 325 cases of E. coli meningitis, risk factors of severe disease or death were preterm birth, severe hypoglycorrhachia, CSF/blood glucose ratio <0.10, and molecular characteristics of strains, which should help optimize therapeutic management.
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Affiliation(s)
- Romain Basmaci
- Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli AP-HP, Service de Pédiatrie Générale
| | - Stéphane Bonacorsi
- Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli
| | - Philippe Bidet
- Infection, Antimicrobials, Modelling, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Institut National de la Santé Et de la Recherche Médicale IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli
| | - Valérie Biran
- AP-HP, Service de Réanimation et Pédiatrie Néonatales, Hôpital Robert-Debré, Paris
| | - Yannick Aujard
- AP-HP, Service de Réanimation et Pédiatrie Néonatales, Hôpital Robert-Debré, Paris
| | - Edouard Bingen
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire de Microbiologie, Centre National de Référence associé Escherichia coli
| | - Stéphane Béchet
- Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés
| | - Robert Cohen
- Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés Groupe de Pathologie Infectieuse Pédiatrique, Paris Unité Court Séjour, Petits Nourrisson, Service de Néonatologie Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, France
| | - Corinne Levy
- Association Clinique Thérapeutique Infantile du Val de Marne, Saint Maur des Fossés Groupe de Pathologie Infectieuse Pédiatrique, Paris Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, France
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Trends of pneumococcal meningitis in children after introduction of the 13-valent pneumococcal conjugate vaccine in France. Pediatr Infect Dis J 2014; 33:1216-21. [PMID: 25037044 DOI: 10.1097/inf.0000000000000451] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Streptococcus pneumoniae remains an important cause of bacterial meningitis in children younger than 2 years. Here, we analyzed data from an active surveillance network established 12 years ago by the Pediatric Infectious Disease Group and the Pediatric Clinical and Therapeutical Association to analyze the impact of pneumococcal conjugate vaccine (PCV7 implemented in 2002 and PCV13 in 2010) on pneumococcal meningitis (PM). METHODS Two hundred twenty-seven pediatric wards working with 168 microbiology departments throughout France were asked to report all cases of PM. RESULTS From 2001 to 2012, among 4808 bacterial meningitis cases, 1406 cases of PM (29.2%) were reported. After PCV13 implementation, from 2009 to 2012, the number of cases significantly decreased by 27.4% (P = 0.041, Cuzick trend test). For children younger than 2 years, the decrease was 28.2% (P = 0.039, Cuzick trend test). In the same period, the decrease was 66.7% in cases due to 6 additional PCV13 types, and the number of cases due to nonvaccine types remained stable. In 2012, the non-PCV13 serotype represented 67.6% of cases and were mainly represented by 12F (15%), 24F (15%), 22F (7%) and 15B/C (7%). For 88.6% of cases, initial antibiotic treatment was vancomycin with a third-generation cephalosporin. Overall mortality was 10.6%, most deaths (86.4%) occurred before day 15. CONCLUSIONS Two years after the PCV13 implementation, we found an impact on PM cases particularly for children younger than 2 years.
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Impact of the pneumococcal conjugate vaccines on invasive pneumococcal disease in France, 2001-2012. Vaccine 2014; 33:359-66. [PMID: 25448105 DOI: 10.1016/j.vaccine.2014.11.011] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/15/2014] [Accepted: 11/10/2014] [Indexed: 01/01/2023]
Abstract
CONTEXT AND AIMS Vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7) was recommended in France in 2003 for children <2 years. The 13-valent conjugate vaccine (PCV13) replaced PCV7 in 2010. We assessed the impact of PCVs vaccination on the incidence of invasive pneumococcal diseases (IPD) in French children (0-15 years) and adults (>15 years). METHODS IPD rates were calculated using cases reported from 2001 to 2012 to Epibac, a laboratory network. The distribution of serotypes was assessed from invasive isolates serotyped at the National reference Centre for Pneumococci. IPD incidence rates were compared between the pre-PCV7 (2001-2002), late PCV7 (2008-2009) and post PCV13 (2012) periods. RESULTS The PCVs coverage increased from 56% in the 2004 birth-cohort to 94% in the 2008 and following birth-cohorts. Following PCV7 introduction, IPD incidence decreased by 19% between 2001-2002 and 2008-2009 in children <2 years, but increased in children aged 2-15 years and adults, despite a sharp decline in PCV7-IPD in all age-groups. After PCV13 introduction, IPD incidence decreased by 34% in children <5 years, by 50% in those aged 5-15 years and 15% in adults from 2008-2009 to 2012. The incidence of PCV13-Non PCV7-IPD decreased by 74% in children <5 years and by 60% in those aged 5-15 years. CONCLUSIONS Vaccination with PCV13 was rapidly followed by a decrease in the incidence of all-type IPD in children, in relation with a sharp decrease in the incidence of PCV13-Non PCV7-IPD. Moreover, all-type IPD decreased after PCV13 introduction in older non-vaccinated age-groups, with a shift in the distribution of serotypes. Considering the whole 2001-2012 period, the vaccination with PCV7 and PCV13 resulted in a decline in the incidence of IPD in children up to the age of 5 but not in older children and adults.
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Levy C, Bidet P, Bonacorsi S, Béchet S, Cohen R. Caractéristiques des méningites à streptocoque du groupe A de l’enfant. Arch Pediatr 2014; 21 Suppl 2:S101-3. [DOI: 10.1016/s0929-693x(14)72270-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Levy C, Varon E, Taha MK, Béchet S, Bonacorsi S, Cohen R, Bingen E. Évolution des méningites bactériennes de l’enfant en France sous l’effet des vaccinations. Arch Pediatr 2014; 21:736-44. [DOI: 10.1016/j.arcped.2014.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/17/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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Quenot JP, Luyt CE, Roche N, Chalumeau M, Charles PE, Claessens YE, Lasocki S, Bedos JP, Péan Y, Philippart F, Ruiz S, Gras-Leguen C, Dupuy AM, Pugin J, Stahl JP, Misset B, Gauzit R, Brun-Buisson C. Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy. Ann Intensive Care 2013; 3:21. [PMID: 23830525 PMCID: PMC3716933 DOI: 10.1186/2110-5820-3-21] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/08/2013] [Indexed: 12/13/2022] Open
Abstract
Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0.25 ng/mL); in patients having nosocomial LRTI, data are insufficient to recommend initiating therapy based on a single PCT level or even repeated measurements. For children with suspected bacterial meningitis, we recommend using a decision rule as an aid to therapeutic decisions, such as the Bacterial Meningitis Score or the Meningitest®; a single PCT level ≥0.5 ng/mL also may be used, but false-negatives may occur. In adults with suspected bacterial meningitis, we suggest integrating serum PCT measurements in a clinical decision rule to help distinguish between viral and bacterial meningitis, using a 0.5 ng/mL threshold. For ICU patients suspected of community-acquired infection, we do not recommend using a threshold serum PCT value to help the decision to initiate antibiotic therapy; data are insufficient to recommend using PCT serum kinetics for the decision to initiate antibiotic therapy in patients suspected of ICU-acquired infection. In children, CRP can probably be used to help discontinue therapy, although the evidence is limited. In adults, antibiotic discontinuation can be based on an algorithm using repeated PCT measurements. In non-immunocompromised out- or in- patients treated for RTI, antibiotics can be discontinued if the PCT level at day 3 is < 0.25 ng/mL or has decreased by >80-90%, whether or not microbiological documentation has been obtained. For ICU patients who have nonbacteremic sepsis from a known site of infection, antibiotics can be stopped if the PCT level at day 3 is < 0.5 ng/mL or has decreased by >80% relative to the highest level recorded, irrespective of the severity of the infectious episode; in bacteremic patients, a minimal duration of therapy of 5 days is recommended.
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Affiliation(s)
- Jean-Pierre Quenot
- Service de Réanimation médicale, Hôpitaux Universitaires Henri Mondor, AP-HP & Université Paris-Est, 51, av de Lattre de Tassigny, 94000 Créteil, France.
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Guet-Revillet H, Levy C, Andriantahina I, Kalach N, Pierre MH, Elbez-Rubinstein A, Boniface C, Berche P, Cohen R, Ferroni A. Paediatric epidemiology of Pasteurella multocida meningitis in France and review of the literature. Eur J Clin Microbiol Infect Dis 2013; 32:1111-20. [DOI: 10.1007/s10096-013-1866-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
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[What do pediatricians and general practitioners think about the implementation of meningococal B vaccination in France?]. Arch Pediatr 2012; 19:1379-85. [PMID: 23159343 DOI: 10.1016/j.arcped.2012.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/01/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND To assess the acceptability of a vaccine against meningococcus B by pediatricians and GP and to analyze how the vaccine could be implemented in France, InfoVac-France has set up a national survey. METHODS An email explained the purpose of this study and the practitioners of InfoVac-France network answered an online questionnaire (e-CRF). RESULTS Of the 6905 pediatricians and GP who saw the mail sent by InfoVac-France between 11 and 24 January, 2012, 1351 (13.5 %) completed the e-CERF : 361 GP (26.7%), 797 pediatricians (59%) and 193 other doctors (14.3%). The majority of practitioners (96.1%) believe that is important to implement a vaccine against meningococcus B in the French immunization schedule. In 80.5% of cases, practitioners do not want to vaccine three times routinely during a single consultation and more than half (53.5%) would prefer to use this vaccine alone. The best schedule of primary vaccination (80.6%) is the injection at 3, 5 and 6 months. The arguments considered likely to encourage parents to accept the vaccination would be the incidence of the disease, severity of meningitis (82.1%) and the rapid mortality (82.8%). CONCLUSION This survey by InfoVac-France shows that the practitioners know the epidemiology of meningococcal B invasive disease in children. They would support the implementation of this vaccine for children under 2 years with a primary vaccination at 3, 5 and 6 months.
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Levy C, Taha MK, Bingen E, Cohen R. Méningites à méningocoques de l’enfant en France: résultats de l’observatoire ACTIV/GPIP. Arch Pediatr 2012; 19 Suppl 2:S49-54. [DOI: 10.1016/s0929-693x(12)71273-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Les Observatoires Nationaux en pédiatrie : organisation et résultats. Arch Pediatr 2012. [DOI: 10.1016/s0929-693x(12)71119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Grammatico-Guillon L, Thiercelin N, Mariani S, Lecuyer AI, Goudeau A, Bernard L, Rusch E. Étude des séjours pour pneumopathie à Streptococcus pneumoniae entre 2004 et 2008 en région Centre. Rev Epidemiol Sante Publique 2012; 60:1-8. [DOI: 10.1016/j.respe.2011.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/16/2011] [Accepted: 07/11/2011] [Indexed: 11/30/2022] Open
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Andrade AL, Toscano CM, Minamisava R, Costa PS, Andrade JG. Pneumococcal disease manifestation in children before and after vaccination: what's new? Vaccine 2012; 29 Suppl 3:C2-14. [PMID: 21896349 DOI: 10.1016/j.vaccine.2011.06.096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/24/2011] [Indexed: 12/25/2022]
Abstract
Pneumococcal infections remain a relevant cause of morbidity and mortality in children, especially in countries where vaccination has not been introduced. In contrast to the common belief by many pediatricians, the most important pneumococcal infections are of the respiratory tract and not invasive diseases. The recent pandemic of the H1N1 virus prompted studies to better understand the interaction between the influenza virus, Streptococcus pneumoniae, and pneumonia outcomes. Radiological findings of bacteremic pneumonia have been well investigated and besides the typical alveolar consolidation, a broad spectrum of atypical patterns has been reported. Molecular techniques, such as real-time polymerase chain reaction (PCR), can improve the detection of S. pneumoniae in sterile fluids, mainly in regions where previous antibiotic therapy is a common practice. In the post vaccination era, new manifestations of pneumococcal invasive disease, such as hemolytic uremic syndrome, have increased in association with parapneumonic empyema. Moreover, serotypes not included in PCV7, particularly serotypes 1, 3, 5, 7F, and 19A, have been among the most common isolates in pneumococcal disease. In Latin America, pneumococcal primary peritonitis has been described as an important clinical syndrome in a growing proportion of patients, mainly in girls. The development of newer and more specific diagnostic markers to distinguish bacterial and viral pneumonia are urgently sought, and will be especially pertinent after the introduction of pneumococcal conjugate vaccines with expanded serotypes. Such markers would minimize inappropriate diagnosis of false positive cases and treatment with antibacterial agents, while increasing positive predictive values for diagnosis of bacterial pneumonia. The extension of serotype coverage with the new conjugate vaccines is promising for pneumococcal infections and coverage against antibiotic-resistant strains.
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Affiliation(s)
- Ana Lucia Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Rua 235, esq 1a. Avenida, Setor Leste Universitário, 74605-050 Goiania, Goias, Brazil.
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Abstract
BACKGROUND Neonatal bacterial meningitis remains a severe infectious disease with mortality rates varying between 10% and 15%. The clinical and bacteriologic features of neonatal meningitis collected from January 2001 to December 2007 in a French national survey are presented here. METHODS Cases of neonatal meningitis were prospectively collected by a network of 252 pediatric wards covering 61% of French pediatric wards, associated with 168 microbiology laboratories. Neonatal meningitis was classified as early-onset (d0-d4) and late-onset (d5-d28). Statistical analyses were performed according to gestational age and weight at birth. RESULTS A total of 444 cases of neonatal bacterial meningitis were reported by 114 pediatric wards. Five cases were excluded from analysis. Group B streptococci (GBS) and Escherichia coli accounted respectively for 59% and 28% of the cases, followed by Gram-negative bacilli other than E. coli (4%), other streptococci (4%), Neisseria meningitidis (3%), and Listeria monocytogenes (1.5%). GBS was the most common pathogen both in early-onset (77% vs. 18% for E. coli) and in late-onset meningitis (50% vs. 33% for E. coli). Among preterm infants, E. coli was more commonly isolated (45% vs. 32% for GBS), especially in very preterm infants (54%). GBS was more often involved in seizures than E. coli (41% vs. 25%). The overall mortality rate was 13% but reached 25% in preterm or small for gestational age infants, regardless of the etiology. CONCLUSIONS GBS was the dominant cause of neonatal bacterial meningitis, with 77% of early-onset and 50% of late-onset cases. E. coli was the most common bacteria in preterm infants.
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PneumococcaL meningitis in french children before and after the introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2011; 30:168-70. [PMID: 21298818 DOI: 10.1097/inf.0b013e3181f4cf69] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In France, despite a high rate of pneumococcal conjugate vaccine coverage, the number of cases of pneumococcal meningitis in children did not decline significantly between 2001–2002 (n = 264) and 2007–2008 (n = 244). A decline was observed among children < 2 years old (185 [70.1%] to 134 [54.9%] cases; P = 0.0004), but was counterbalanced by an increase among children ≥ 2 years old (79 [29.9%] to 110 [45.1%] cases). Mean age increased significantly, from 2.3 (median 0.8) to 3.8 (median 1.5) years. After pneumococcal conjugate vaccine 7 implementation, a wide diversity of serotypes implicated in pneumococcalmeningitis was observed; serotypes 19A and 7F were the most frequent.
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Abcès cérébraux multiples à Enterobacter cloacae chez un prématuré. Intérêt de la ciprofloxacine. Arch Pediatr 2010; 17 Suppl 4:S184-7. [DOI: 10.1016/s0929-693x(10)70923-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Association of meningococcal phenotypes and genotypes with clinical characteristics and mortality of meningitis in children. Pediatr Infect Dis J 2010; 29:618-23. [PMID: 20168263 DOI: 10.1097/inf.0b013e3181d3ce32] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neisseria meningitidis meningitis represents approximately one-half of the meningococcal cases in French children. To explore the contribution of bacterial typing in improving the management of cases, we aimed to describe clinical characteristics and mortality of meningococcal meningitis in children reported to the multicenter survey system, GPIP/ACTIV, in association with phenotypes/genotypes of bacterial isolates. METHODS From 2001 to 2005, 259 pediatric wards and 168 microbiology laboratories enrolled all children with bacterial meningitis. Risk factors, vaccination status, signs and symptoms, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. RESULTS A total of 962 cases of Neisseria meningitidis meningitis among a total of 2131 bacterial meningitis (45%) were recorded (mean age, 4.5 +/- 4.7 years). Serogroup distribution of the isolates was 62.3%, 33.7%, 2.9%, 0.6%, and 0.6% for serogroups B, C, W135, A and Y, respectively. The major clonal complexes were ST-41/44 (32.2%), ST-11 (21.9%), ST-32 (20.8%), ST-8 (8.2%), and ST-269 (4.9%). Despite global heterogeneity of the isolates, 2 phenotypes/genotypes were of interest. Isolates of the phenotype/genotype B:14:P1.7,16/ST-32 (56% clustered in the region of Haute Normandie) were observed in older children (8.6 years) and were associated with a higher case fatality rate (12%) than were other phenotypes of serogroup B. The phenotype/genotype C:2a:P1.5/ST-11 was found in 26.3% of serogroup C cases and was possibly associated with a higher mortality among serogroup C (9.9% for C and 5.9% for B, P = 0.04). CONCLUSIONS This large survey provides data that could be important for implementation of future vaccines. Typing of meningococcal isolates could contribute to an understanding of prognosis in meningococcal meningitis.
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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: 513] [Impact Index Per Article: 36.6] [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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Abstract
PURPOSE OF REVIEW Distinguishing between bacterial and aseptic meningitis in children is sometimes difficult. Guidelines recommend that patients with acute meningitis be systematically hospitalized and treated with antibiotics until the cerebrospinal fluid culture results are available. This strategy ensures rapid treatment for bacterial meningitis, but also involves unnecessary admissions and antibiotics for aseptic meningitis. Some authors have, therefore, proposed different combinations of predictors in clinical decision rules to distinguish as early as possible between bacterial and aseptic meningitis. To be useful, these rules must have near-100% sensitivity for bacterial meningitis, good specificity (to reduce unnecessary antibiotics and admissions), and easy bedside application. RECENT FINDINGS The present review examines the performance and level of validation of decision rules proposed after the Haemophilus influenzae vaccination entered widespread use. Most of these rules have been validated incompletely, if at all. Only one rule incorporates the best single validated predictive marker for distinguishing between bacterial and aseptic meningitis in children: serum procalcitonin level. SUMMARY Two rules are highly promising, meeting the three major conditions after a retrospective validation process in large samples. These rules can be applied cautiously to patients with the same inclusion and exclusion criteria as those in the derivation sets, while awaiting prospective multicenter validation studies.
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Levy C, de La Rocque F, Cohen R. Actualisation de l’épidémiologie des méningites bactériennes de l’enfant en France. Med Mal Infect 2009; 39:419-31. [DOI: 10.1016/j.medmal.2009.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Haas H. Antibiothérapie d’une méningite présumée bactérienne de l’enfant (rationnel, modalités, durée, suivi). Med Mal Infect 2009; 39:647-58. [DOI: 10.1016/j.medmal.2009.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Dubos F. Stratégie de prise en charge (diagnostic, surveillance, suivi) d’une méningite présumée bactérienne de l’enfant. Med Mal Infect 2009; 39:615-28. [DOI: 10.1016/j.medmal.2009.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Carbonnelle E. Apport des examens biologiques dans le diagnostic positif, la détermination de l’étiologie et le suivi d’une méningite suspectée bactérienne. Med Mal Infect 2009; 39:581-605. [DOI: 10.1016/j.medmal.2009.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 01/03/2023]
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Crouzet-Ozenda L, Haas H, Bingen E, Lécuyer A, Levy C, Cohen R. [Listeria monocytogenes meningitis in children in France]. Arch Pediatr 2009; 15 Suppl 3:S158-60. [PMID: 19268247 DOI: 10.1016/s0929-693x(08)75500-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Listeriosis is a serious invasive disease which affects mainly pregnant women, newborns and immunocompromised adults. OBJECTIVE To analyze specifically the epidemiological and clinical data of the meningitis due to Listeria monocytogenes (Lm), from the French Network of Surveillance of Bacterial Meningitis in childhood. PATIENTS AND METHODS Patients were aged 0 to 18 years. The diagnosis was based on a combination of a feverish meningeal syndrome and a positive culture of cerebrospinal fluid (CSF) and/or a positive PCR in the CSF and/or positive blood culture associated with a pleiocytose. RESULTS Among 2539 cases of bacterial meningitis recorded in 6 years (2001 to 2006), 18 cases were due to Lm (0.7 %) (sex ratio M / F : 0.8). The average of age was 2.5 years (median : 0.5 ; ext : 0-15.1). The serotype of Lm was 4B in half of the cases. Most cases have occured in summer and autumn. Two patients presented an acquired or congenital immunodeficiency. Fifty-six percent (n=10) were younger than 1 year, among them, 7 were newborns. The CSF direct microbiologic investigation was suggestive of Lm (Gram positive bacilli) only in two cases, but the culture of CSF was positive for 16 patients and the blood culture was positive for 2 other patients. Three of 18 patients died between 7 and 13 days after admittance : a premature baby of 25 weeks'gestational age, two full-term newborns of 2 days and 1.5 months old. The mortality rate was 16.7 % before the age of 1 year (no death after this age). CONCLUSION Meningitis due to Lm remains a rare disease, including in neonatal period. The recent increase of cases in adults requires to maintain vigilance in children especially since direct examination of CSF can rarely allow the diagnosis.
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Affiliation(s)
- L Crouzet-Ozenda
- Urgences pédiatriques, Hôpital Archet 2, 151 route de St Antoine de Ginestière, 06202 Nice
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Levy C, Taha MK, Weill Olivier C, Quinet B, Lécuyer A, Alonso JM, Cohen R, Bingen E. [Characteristics of meningococcal meningitis in children in France]. Arch Pediatr 2009; 15 Suppl 3:S105-10. [PMID: 19268239 DOI: 10.1016/s0929-693x(08)75492-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In France, meningococcal meningitis account for 50% of bacterial meningitis in children. The GPIP/ACTIV (Groupe de Pathologie Infectieuse Pédiatrique and Association Clinique et Thérapeutique Infantile du Val de Marne) set up an active surveillance network to analyze the epidemiological, clinical and biological features of meningococcal meningitis. METHODS From 2001 to 2007, 252 French paediatric wards working with 166 microbiology laboratories enrolled all children (0-18 years old) with bacterial meningitis. Risk factors, signs and symptoms, vaccination status, cerebrospinal fluid analysis, treatments and case fatality rate were recorded. RESULTS During the period of the study, 1344 meningococcal meningitis were reported among 2951 (45.5%) bacterial meningitis. Mean age was 4.4 years (+/-4.7, median 2.5) and 2/3 cases occurred in children under 5 years (68.5%). Serogroup B (59.1%) was preponderant following by serogroup C (28.9%). 25% of children had received an antibiotic treatment 24hours before lumbar puncture. A shock was reported in 31.3% of cases. Cerebrospinal fluid culture was positive in 73% of cases. All N. meningitidis isolates were susceptible to cefotaxime and ceftriaxone while 41.6% and 25.7% showed reduced susceptibility to penicillin and amoxicillin respectively. Two cases of meningitis due to isolates of serogroups C and B were reported in two children that were respectively vaccinated using A+C plain saccharide vaccine or two doses of MenBvac vaccine. All patients had received beta-lactamin. Global case fatality rate was 6.6% but was higher (9.9%) for serogroup C than for serogroup B (5.5%) (p=0,007). CONCLUSION This study is among the largest series of microbiologically documented meningococcal meningitis to date (more than 1300 cases). In France, meningococal is responsible for 50 % of meningitis. Effective meningococcal serogroup B vaccine and serogroup C vaccination recommendation could lessen considerably the burden of meningococal meningitis.
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Affiliation(s)
- C Levy
- GPIP (Groupe de Pathologie Infectieuse Pédiatrique) de la SFP (Société Française de Pédiatrie), 27 rue Inkermann, F94100 Saint Maur des Fossés, France.
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Grimprel E. [Corticosteroids in children with bacterial meningitis: indications and administration]. Med Mal Infect 2009; 39:539-46. [PMID: 19394773 DOI: 10.1016/j.medmal.2009.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/20/2009] [Indexed: 11/19/2022]
Abstract
The use of dexamethasone (DXM) as adjunctive therapy for bacterial meningitis (BM) in infants and children has remained controversial for 20 years. In spite of solid pathophysiological arguments, the limited number of patients, methodological flaws in clinical studies taken individually and pooled into meta-analyses, and the emergence of pneumococcal cephalosporin-resistance did not allow to reach a consensus on the effectiveness of DXM in the prevention of neurological sequelae, in the course of non Haemophilus influenzae b (Hib) BM. A recent meta-analysis conducted with an adequate number of patients (2,750 patients including 2,074 infants and children below 15 years of age) demonstrated that DXM prevented mortality and sequelae in adults with pneumococcal meningitis and suggested that this efficacy could also apply to infants and children. Data from the active surveillance networks of pediatric BM and pneumococcal resistance in France suggested that DXM anti-inflammatory effect on antibiotic CSF penetration would not have a significant impact on the bactericidal efficacy if recommended dosages of cefotaxime (300 mg/kg per day) and vancomycin (60 mg/kg per day) were used. DXM could be considered in the early treatment of pneumococcal BM in infants and children in industrialized countries. But there is no proven efficacy of DXM in meningococcal meningitis in infants and children.
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Affiliation(s)
- E Grimprel
- Groupe de pathologie infectieuse pédiatrique de la Société française de pédiatrie, France.
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40
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Hentgen V, Levy C, Bingen E, Cohen R. [Group A streptococcal meningitis in children: clinical characteristics and outcome]. Arch Pediatr 2009; 15 Suppl 3:S154-7. [PMID: 19268246 DOI: 10.1016/s0929-693x(08)75499-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND METHOD Group A streptococcal (GAS) invasive infections have been increasingly reported in recent years but meningitis due to GAS remains a rare affection. In children some scarce case reports have been described. The aim of this study was to describe and analyze the clinical and biological data on GAS meningitis recorded in the Bacterial Meningitis (BM) French Surveillance Network (GPIP/ACTIV). RESULTS From 2001 through end 2006, 2539 children suffering from proven bacterial meningitis were recorded in the data base. Among them 10 children presented GAS infections. The mean age was 6 years (9 months to 14.1 years) and the sex ratio (male/female) 4/1. Seven out of the 10 patients had a history of community acquired infection before the onset of GAS meningitis : 3 had previous acute otitis media, 1 otitis media with mastoiditis, 2 sinusitis and 1 soft tissue infection. In the 3 remaining children no risk factors of invasive GAS infection could be identified. All but 1 patient survived. The patient who died had no risk factors for invasive infectious disease. He presented with fulminant septicaemia and died 6hours after hospital admission despite appropriate supportive care and prompt antibiotic treatment. The cerebrospinal fluid examination revealed high white blood cells counts (>500/mm(3)) in 8 patients and Gram stained smear showed gram-positive cocci in 6 patients. All the patients received antibiotic regimen including 3(rd) generation cephalosporins before definite bacterial identification and all the strains were susceptible to the first line antibiotic treatment chosen. CONCLUSION GAS is an uncommon organism causing meningitis in children. In our study upper respiratory tract infection is the most common predisposing factor for GAS meningitis but even apparently healthy children can suffer from this severe form of bacterial meningitis.
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Affiliation(s)
- V Hentgen
- Service de pédiatrie, Hop de Versailles, Le Chesnay; GPIP : Groupe de Pathologie Infectieuse Pédiatrique.
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Abstract
Bacterial meningitis is still an important infectious disease with a high morbidity and mortality rate. Bacterial infection of the cerebrospinal fluid (CSF) space causes a powerful inflammatory reaction that is largely responsibly for meningitis-induced tissue damage and adverse outcome of the disease. In a landmark series of experiments in the mid-1980s, cell wall components including lipooligosaccharides and lipoteichoic acid were indicated to be the key bacterial elements that can trigger the host inflammatory response in the CSF. Ten years ago, the discovery of Toll-like receptor proteins (TLRs) that allow the detection of microbial components and initiate the host immune response opened up new horizons in research on the pathophysiology of meningitis. Cell culture approaches provided the first evidence for a crucial role of TLRs in sensing meningeal pathogens including Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus agalactiae, and Listeria monocytogenes. Subsequently, studies in mice with single or combined deficiencies in TLRs demonstrated that TLR activation is a key event in meningeal inflammation and, even more interestingly, a pivotal factor for meningitis-associated tissue damage. A detailed understanding of the mechanisms of host-pathogen interactions in the CSF space may generate new opportunities for specific treatment strategies for bacterial meningitis.
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Ceyhan M. Pneumococcal seroepidemiology in Turkey. Vaccine 2008; 26:6745. [PMID: 18948161 DOI: 10.1016/j.vaccine.2008.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 10/02/2008] [Indexed: 11/28/2022]
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Deutch S, Møller JK, Ostergaard L. Combined assay for two-hour identification of Streptococcus pneumoniae and Neisseria meningitidis and concomitant detection of 16S ribosomal DNA in cerebrospinal fluid by real-time PCR. ACTA ACUST UNITED AC 2008; 40:607-14. [PMID: 18979598 DOI: 10.1080/00365540801914833] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The main object was to examine the diagnostic performance of a novel combination of a specific real-time PCR (combined real-time PCR) for immediate and simultaneous detection of Streptococcus pneumoniae and Neisseria meningitidis and of a real-time PCR of the 16S rRNA gene (16S DNA). During 12 months, 1015 routine CSF samples were consecutively collected from patients in the County of Aarhus, Denmark. The samples were cultured, examined by microscopy, and, in parallel, CSF DNA was automatically purified and subjected to real-time PCR. Melting curve analysis discriminated between the 2 specific pathogens and 16S DNA positive samples were sequenced. Clinical data were extracted from patients having positive samples. Clinically, 35 of 46 (76%) patients with positive samples had bacterial meningitis. 18 of these 35 patients had a concomitant culture and real-time PCR-positive sample. The remaining 17 patients were either culture positive (n =7) or real-time PCR-positive (n = 10). The aetiology of bacterial meningitis was revealed by microscopy in 18/35 (51.4%), culture in 24/35 (68.6%) and combined real-time PCR in 27/35 (77.1%) patients, respectively. In conclusion, the combined real-time PCR strategy is superior to microscopy and a valuable supplement to routine culture to establish the aetiology of bacterial meningitis.
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Affiliation(s)
- Susanna Deutch
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
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Caractéristiques cliniques, biologiques et évolutives des méningites à streptocoque du groupe B de l'enfant. Arch Pediatr 2008; 15 Suppl 3:S126-32. [DOI: 10.1016/s0929-693x(08)75495-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Observatoire national des méningites bactériennes de l'enfant en France : résultats de 7 années d'étude. Arch Pediatr 2008; 15 Suppl 3:S99-S104. [DOI: 10.1016/s0929-693x(08)75491-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hées L, Gillet Y, Levy C, Varon E, Bingen E, Cohen R, Floret D. Stérilisations retardées du liquide céphalorachidien au cours des méningites à pneumocoque de l'enfant. Arch Pediatr 2008; 15 Suppl 3:S119-25. [DOI: 10.1016/s0929-693x(08)75494-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Guillaumat C, Dang-Duy TL, Levy C, Cohen R, Leblanc A. Méningites à salmonelles du nouveau-né et du nourrisson. Intérêt des fluoroquinolones. Arch Pediatr 2008; 15 Suppl 3:S161-6. [DOI: 10.1016/s0929-693x(08)75501-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48
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Dagan R. Use of Pneumococcal Conjugate Vaccine to Decrease Rates of Bacterial Meningitis. Clin Infect Dis 2008; 46:1673-6. [DOI: 10.1086/587898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Levy C, Bingen E, De La Rocque F, Varon E, Alonso JM, Dabernat H, Aujard Y, Cohen R. Des échecs des vaccinations contre les méningites bactériennes ? Arch Pediatr 2008; 15:545-7. [DOI: 10.1016/s0929-693x(08)71828-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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