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El Tahir O, Groenveld J, Jonge R, Oostrom K, Goei SL, Pronk J, Furth AM. Self-Reported Executive Functioning in Young Adult Survivors of Childhood Bacterial Meningitis. Arch Clin Neuropsychol 2024:acae040. [PMID: 38797959 DOI: 10.1093/arclin/acae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE This study investigated executive functions (EFs) in young adult survivors of childhood bacterial meningitis (BM). These skills are important for normal development, and their potential vulnerability in early years suggests that childhood BM could affect executive functions in the longer term. METHOD The adult self-report Behavior Rating Inventory of Executive Function was administered to 474 young adult survivors of childhood BM who participated in the 20|30 Dutch Postmeningitis study. Average scores were compared to population-norm group scores. Subgroup scores were compared according to causative pathogen and age at onset. RESULTS Young adult survivors of childhood BM scored lower on overall metacognition than the age-matched population norm group. Young adult survivors of childhood BM caused by Streptococcus pneumoniae, S. agalactiae, or Escherichia coli had lower scores than cases caused by Neisseria meningitidis. Survivors with age-at-onset below 12 months had a higher (worse) overall EF score than survivors with age-at-onset above 12 months. CONCLUSIONS Young adult survivors of childhood BM experience difficulties in EF. However, most of the self-reported EF scores were within the norm. Future studies need to additionally assess EF in adult survivors of childhood BM using performance-based tests.
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Affiliation(s)
- Omaima El Tahir
- Department of Pediatric Infectious Diseases and Immunology, AI&II, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia Groenveld
- Department of Pediatric Infectious Diseases and Immunology, AI&II, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rogier Jonge
- Department of Pediatric and Neonatal Intensive Care Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Kim Oostrom
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sui Lin Goei
- LEARN! Learning Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Pronk
- Expertise Group Child Health, the Netherlands Organization for Applied Scientific Research (TNO), Leiden, the Netherlands
| | - Anne Marceline Furth
- Department of Pediatric Infectious Diseases and Immunology, AI&II, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Garg K, Bhandari RK, Shafiq N, Jain S, Jaswal S, Chawla D, Mallayasamy S, Khurana S, Batcha JSD. Population pharmacokinetics of ciprofloxacin in newborns with early onset neonatal sepsis and suspected meningitis. Pediatr Res 2024; 95:1273-1278. [PMID: 38062257 DOI: 10.1038/s41390-023-02941-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND Neonatal Sepsis accounts for significant proportion of neonatal mortality globally. Ciprofloxacin can be used as an effective antimicrobial against common causative agents of neonatal sepsis. However, there is only limited information about its pharmacokinetic distribution in plasma and Cerebrospinal fluid (CSF) of neonates. METHODS Plasma and CSF samples were taken using a sparse sampling technique from neonates who received at least one dose of intravenous ciprofloxacin. Ciprofloxacin levels were analysed using high-performance liquid chromatography (HPLC). Population pharmacokinetic analysis was conducted using a non-linear mixed-effects modelling using Pumas® (Pharmaceutical Modelling and Simulation) package (Version 2.0). RESULTS 53 neonates were enroled in the study of whom; 9 (17%) had meningitis. The median concentration of ciprofloxacin in CSF was 1.4 (0.94-2.06) ug/ml and plasma was 2.94 (1.8-5.0) ug/ml. A one-compartment model with first-order elimination fitted the data. Body weight was found to be a significant covariate on volume of distribution (Vd). Simulations based on the final model suggest that dose of 10 mg/kg, intravenous b.d may not be able to achieve the desirable indices. CONCLUSIONS One compartment model with weight as a covariate explained the available data. Further studies with modified sampling strategy, larger sample size and variable dose levels are needed.
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Affiliation(s)
- Kunal Garg
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Ritika Kondel Bhandari
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Surulivelrajan Mallayasamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Supreet Khurana
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India.
| | - Jaya Shree Dilli Batcha
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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Verlinden I, Güiza F, Dulfer K, Van Cleemput H, Wouters PJ, Guerra GG, Joosten KF, Verbruggen SC, Vanhorebeek I, Van den Berghe G. Physical, Emotional/Behavioral, and Neurocognitive Developmental Outcomes From 2 to 4 Years After PICU Admission: A Secondary Analysis of the Early Versus Late Parenteral Nutrition Randomized Controlled Trial Cohort. Pediatr Crit Care Med 2022; 23:580-592. [PMID: 35522534 PMCID: PMC9345517 DOI: 10.1097/pcc.0000000000002971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES PICU patients face long-term developmental impairments, partially attributable to early parenteral nutrition (PN) versus late-PN. We investigated how this legacy and harm by early-PN evolve over time. DESIGN Preplanned secondary analysis of the multicenter PEPaNIC-RCT (ClinicalTrials.gov, NCT01536275) that enrolled 1,440 critically ill children from 2012 to 2015 and its 2- (2014-2018) and 4-year (2016-2019) cross-sectional follow-up studies. SETTING PICUs of Leuven (Belgium), Rotterdam (The Netherlands), and Edmonton (Canada). PATIENTS Patients and demographically matched healthy control children that underwent longitudinal assessment for physical/emotional/behavioral/neurocognitive functions at both follow-up time points. INTERVENTIONS In the PEPaNIC-RCT, patients were randomly allocated to early-PN versus late-PN. MEASUREMENTS AND MAIN RESULTS This within-individual longitudinal study investigated changes in physical/emotional/behavioral/neurocognitive functions from 2 to 4 years after PICU admission for 614 patients (297 early-PN and 317 late-PN, tested at mean ± sd age 5.4 ± 4.2 and 7.3 ± 4.3 yr) and for 357 demographically matched healthy children tested at age 5.6 ± 4.3 and 7.5 ± 4.3 years. We determined within-group time-courses, interaction between time and group, and independent impact of critical illness and early-PN on these time-courses. Most deficits in patients versus healthy children remained prominent over the 2 years ( p ≤ 0.01). Deficits further aggravated for height, body mass index, the executive function metacognition, intelligence, motor coordination (alternating/synchronous tapping), and memory learning-index, whereas verbal memory deficits became smaller (working/immediate/delayed memory) ( p ≤ 0.05). Adjustment for risk factors confirmed most findings and revealed that patients "grew-into-deficit" for additional executive functions (flexibility/emotional control/total executive functioning) and "grew-out-of-deficit" for additional memory functions (recognition/pictures) ( p ≤ 0.05). Time-courses were largely unaffected by early-PN versus late-PN, except for weight loss and limited catch-up for visual-motor integration and alertness in early-PN patients ( p ≤ 0.05). CONCLUSIONS From 2- to 4-year post-PICU admission, developmental impairments remained prominent. Within that time-window, impaired growth in height, executive functioning and intelligence aggravated, and impaired memory and harm by early-PN only partially recovered. Impact on development into adulthood requires further investigation.
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Affiliation(s)
- Ines Verlinden
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Karolijn Dulfer
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanna Van Cleemput
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Pieter J Wouters
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Gonzalo Garcia Guerra
- Department of Paediatrics, Intensive Care Unit, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Koen F Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sascha C Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilse Vanhorebeek
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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Qu L, Dong Z, Ma S, Liu Y, Zhou W, Wang Z, Wu C, Ma R, Jiang X, Zu T, Cheng M, Wu Y. Gut Microbiome Signatures Are Predictive of Cognitive Impairment in Hypertension Patients—A Cohort Study. Front Microbiol 2022; 13:841614. [PMID: 35464979 PMCID: PMC9024414 DOI: 10.3389/fmicb.2022.841614] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/26/2022] [Indexed: 12/29/2022] Open
Abstract
Growing evidence has demonstrated that hypertension was associated with dysbiosis of intestinal flora. Since intestinal microbes could critically regulate neurofunction via the intestinal–brain axis, the study aimed to reveal the role and prediction value of intestinal flora alteration in hypertension-associated cognitive impairment. A cohort of 97 participants included 63 hypertension patients and 34 healthy controls. The structure of intestinal flora was analyzed by V3–V4 16S rRNA amplicon sequencing. The cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, and 31 patients were considered to have cognitive impairment (MoCA < 26). Patients with cognitive impairment had considerable alterations in intestinal flora structure, composition, and function compared with normal-cognitive patients. In particular, the abundance of LPS-containing taxa (Proteobacteria, Gammaproteobacteria, Enterobacterales, Enterobacteriaceae, and Escherichia–Shigella) and SCFA-producing taxon (Prevotella) significantly changed in cognition-impaired patients. Tax4Fun predication results showed downregulation of glycan biosynthesis and metabolism in hypertension patients with cognitive impairment. Additionally, the pathway was demonstrated to be significantly correlated with LPS-containing taxa (Proteobacteria, Gammaproteobacteria, Enterobacterales, Enterobacteriaceae, and Escherichia–Shigella) and SCFA-producing taxon Prevotella. Furthermore, the taxa-based multiple joint prediction model (9×) was demonstrated to have excellent diagnostic potential for cognitive impairment of hypertension patients (AUC = 0.944). The current study revealed the involvement of intestinal microbiota dysbiosis in cognition-impaired hypertension patients and provided an objective predictive index for this cognition disorder.
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Affiliation(s)
- Lei Qu
- Department of Pathogenic Biology, Binzhou Medical University, Yantai, China
| | - Zhouyan Dong
- Department of Pathogenic Biology, Binzhou Medical University, Yantai, China
| | - Songcui Ma
- Yantai Yuhuangding Hospital, Yantai, China
| | - Yaping Liu
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
| | - Wei Zhou
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
| | - Zitong Wang
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
| | - Chen Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Rui Ma
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
| | - Xinze Jiang
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
| | - Tingting Zu
- Clinical Medicine School, Binzhou Medical University, Yantai, China
| | - Mei Cheng
- Institute of Health and Disease Management, Binzhou Medical University, Yantai, China
- *Correspondence: Mei Cheng,
| | - Yulong Wu
- Department of Pathogenic Biology, Binzhou Medical University, Yantai, China
- Yulong Wu,
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7
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Seele J, Ballüer M, Tauber SC, Bunkowski S, Schulz K, Stadelmann C, Beineke A, Pägelow D, Fulde M, Nau R. Neural Injury and Repair in a Novel Neonatal Mouse Model of Listeria Monocytogenes Meningoencephalitis. J Neuropathol Exp Neurol 2021; 80:861-867. [PMID: 34486672 DOI: 10.1093/jnen/nlab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To improve the therapy of neonatal central nervous system infections, well-characterized animal models are urgently needed. The present study analyzes neuropathological alterations with particular focus on neural injury and repair in brains of neonatal mice with Listeria monocytogenes (LM) meningitis/meningoencephalitis using a novel nasal infection model. The hippocampal formation and frontal cortex of 14 neonatal mice with LM meningitis/meningoencephalitis and 14 uninfected controls were analyzed by histology, immunohistochemistry, and in situ tailing for morphological alterations. In the dentate gyrus of the hippocampal formation of mice with LM meningitis/meningoencephalitis, an increased density of apoptotic neurons visualized by in situ tailing (p = 0.04) and in situ tailing plus immunohistochemistry for activated Caspase-3 (p < 0.0001) was found. A decreased density of dividing cells stained with an anti-PCNA-antibody (p < 0.0001) and less neurogenesis visualized by anti-calretinin (p < 0.0001) and anti-calbindin (p = 0.01) antibodies were detected compared to uninfected controls. The density of microglia was higher in LM meningitis (p < 0.0001), while the density of astrocytes remained unchanged. Infiltrating monocytes and neutrophilic granulocytes likely contributed to tissue damage. In conclusion, in the brains of LM-infected mice a strong immune response was observed which led to neuronal apoptosis and an impaired neural regeneration. This model appears very suitable to study therapies against long-term sequelae of neonatal LM meningitis.
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Affiliation(s)
- Jana Seele
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany.,Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
| | - Melissa Ballüer
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany.,Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
| | - Simone C Tauber
- Department of Neurology, RWTH University Hospital, Aachen, Germany
| | - Stephanie Bunkowski
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Katja Schulz
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Christine Stadelmann
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
| | - Andreas Beineke
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Dennis Pägelow
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Freie Universität Berlin, Berlin, Germany
| | - Marcus Fulde
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Freie Universität Berlin, Berlin, Germany
| | - Roland Nau
- Department of Neuropathology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany.,Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany
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Hsieh DY, Lai YR, Lien CY, Chang WN, Huang CC, Cheng BC, Kung CT, Lu CH. Nationwide Population-Based Epidemiological Study for Outcomes of Adjunctive Steroid Therapy in Pediatric Patients with Bacterial Meningitis in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126386. [PMID: 34204785 PMCID: PMC8296207 DOI: 10.3390/ijerph18126386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Although corticosteroids can serve as an effective anti-inflammatory adjuvant therapy, the role of adjunctive steroid therapy in pediatric bacterial meningitis in Taiwan remains under-investigated. Cases of acute bacterial meningitis, aged between 1 month and 20 years, were divided into a steroid group (empirical antibiotics with adjunctive steroid therapy) and a non-steroid group (empirical antibiotics only). Data were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision codes. Of the 8083 episodes enrolled in this study, 26% (2122/8083) and 74% (5961/8083) were divided into the steroid and non-steroid groups, respectively. The fatality rates were 7.9% in the steroid group and 1.7% in the non-steroid group during hospitalization (p < 0.0001). In the steroid and non-steroid groups, the median length of hospital stay was 13 and 6 days, respectively (p < 0.0001). Medical costs (median (interquartile range)) of hospitalization were 77,941 (26,647–237,540) and 26,653 (14,287–53,421) New Taiwan dollars in the steroid and non-steroid groups, respectively (p < 0.0001). The steroid group had a more fulminant course at baseline, a higher fatality rate, length of hospital stay, and medical cost of hospitalization. Therefore, the beneficial effects of the adjunctive use of corticosteroids in pediatric bacterial meningitis are inconclusive, and additional prospective multicenter investigations are required to clarify this issue.
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Affiliation(s)
- Dong-Yi Hsieh
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chia-Yi Lien
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Wen-Neng Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
| | - Ben-Chung Cheng
- Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan; (D.-Y.H.); (Y.-R.L.); (C.-Y.L.); (W.-N.C.); (C.-C.H.)
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence:
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Invasive Haemophilus influenzae Infections after 3 Decades of Hib Protein Conjugate Vaccine Use. Clin Microbiol Rev 2021; 34:e0002821. [PMID: 34076491 DOI: 10.1128/cmr.00028-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Haemophilus influenzae serotype b (Hib) was previously the most common cause of bacterial meningitis and an important etiologic agent of pneumonia in children aged <5 years. Its major virulence factor is the polyribosyl ribitol phosphate (PRP) polysaccharide capsule. In the 1980s, PRP-protein conjugate Hib vaccines were developed and are now included in almost all national immunization programs, achieving a sustained decline in invasive Hib infections. However, invasive Hib disease has not yet been eliminated in countries with low vaccine coverage, and sporadic outbreaks of Hib infection still occur occasionally in countries with high vaccine coverage. Over the past 2 decades, other capsulated serotypes have been recognized increasingly as causing invasive infections. H. influenzae serotype a (Hia) is now a major cause of invasive infection in Indigenous communities of North America, prompting a possible requirement for an Hia conjugate vaccine. H. influenzae serotypes e and f are now more common than serotype b in Europe. Significant year-to-year increases in nontypeable H. influenzae invasive infections have occurred in many regions of the world. Invasive H. influenzae infections are now seen predominantly in patients at the extremes of life and those with underlying comorbidities. This review provides a comprehensive and critical overview of the current global epidemiology of invasive H. influenzae infections in different geographic regions of the world. It discusses those now at risk of invasive Hib disease, describes the emergence of other severe invasive H. influenzae infections, and emphasizes the importance of long-term, comprehensive, clinical and microbiologic surveillance to monitor a vaccine's impact.
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10
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Gundogdu U, Eroglu M. Executive Functions and Theory of Mind Skills of Sexually Abused Female Adolescents and Their Externalizing and the Internalizing Behavioral Problems. JOURNAL OF CHILD SEXUAL ABUSE 2021; 30:427-441. [PMID: 33724170 DOI: 10.1080/10538712.2021.1901169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/29/2020] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Sexually abused children (SAC) often experience acute and chronic adverse psychological and physiological effects later in life. This study aims to evaluate psychiatric diagnoses, Executive Functions (EF) and Theory of Mind (ToM) skills deficiencies in sexually abused female adolescents and examine the relation of these deficiencies with externalizing and internalizing behavioral problems. The patient group comprised 42 female adolescents aged 14-18 years (mean = 16.42, standard deviation = 1.01). The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Dokuz Eylül ToM Index and Reading the Mind in the Eyes test were applied. The Behavior Rating Inventory of Executive Function, Strengths and Difficulties Questionnaire, and Kiddo-KINDL were completed by the participants and their families. A total of 57.2% (n = 24) were classified as SAC with internalizing behavior problems (SAC+I), whereas 66.7% (n = 28) comprised the SAC with externalizing behavior problems (SAC+A) subgroup. SAC+I showed deficits in EF and TOM. Some EF skills were found to be statistically weaker in SAC+A. There was no difference between SAC+A and SAC-A in the TOM tests. The results highlight the need to explore whether these deficiencies are due to psychiatric diseases or whether those who have disabilities in this field carry a higher risk of psychiatric disorder.
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Affiliation(s)
| | - Mehtap Eroglu
- Nigde Omer Halisdemir Training and Research Hospital, Nigde, Turkey
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11
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Schiess N, Groce NE, Dua T. The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review. Microorganisms 2021; 9:microorganisms9050900. [PMID: 33922381 PMCID: PMC8145552 DOI: 10.3390/microorganisms9050900] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
The burden, impact, and social and economic costs of neurological sequelae following meningitis can be devastating to patients, families and communities. An acute inflammation of the brain and spinal cord, meningitis results in high mortality rates, with over 2.5 million new cases of bacterial meningitis and over 236,000 deaths worldwide in 2019 alone. Up to 30% of survivors have some type of neurological or neuro-behavioural sequelae. These include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory or behaviour changes. Few studies have documented the long-term (greater than five years) consequences or have parsed out whether the age at time of meningitis contributes to poor outcome. Knowledge of the socioeconomic impact and demand for medical follow-up services among these patients and their caregivers is also lacking, especially in low- and middle-income countries (LMICs). Within resource-limited settings, the costs incurred by patients and their families can be very high. This review summarises the available evidence to better understand the impact and burden of the neurological sequelae and disabling consequences of bacterial meningitis, with particular focus on identifying existing gaps in LMICs.
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Affiliation(s)
- Nicoline Schiess
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
- Correspondence:
| | - Nora E. Groce
- UCL International Disability Research Centre, Department of Epidemiology and Health Care, University College London, London WC1E 7HB, UK;
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
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Scanferla E, Fasse L, Gorwood P. Subjective experience of meningitis survivors: a transversal qualitative study using interpretative phenomenological analysis. BMJ Open 2020; 10:e037168. [PMID: 32819992 PMCID: PMC7443278 DOI: 10.1136/bmjopen-2020-037168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES (1) To capture the subjective experience of meningitis survivors during adolescence and adulthood and (2) To explore how they give meaning to this specific experience. DESIGN A qualitative study of in-depth interviews using interpretative phenomenological analysis. SETTINGS Participants recruited through an association of persons affected by meningitis and their relatives. PARTICIPANTS Convenience sample of nine participants (seven women and two men) between the ages of 18 to 48 years (mean=28.3, SD=11.4), who personally experienced meningitis. RESULTS Eight major themes and three main meaning-making processes in relation to the participants' experiences of meningitis were identified: (1) the ability to rely on the testimony of others, (2) the impossibility of meaning-making and (3) the possibility of post-traumatic growth. We detailed here five major themes, which appear critical to answering the objective of the study. CONCLUSIONS This study provides a unique insight into the first-hand experience of surviving meningitis. Findings highlighted factors characterising the disease experience, the psychological adjustment of meningitis survivors and their meaning-making processes. These findings are important for both research and clinical practice, demonstrating the importance of direct involvement of meningitis survivors in identifying key aspects of care, which include the critical role of relatives, and the importance of investigating the need for training among healthcare providers on how to diagnose meningitis.
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Affiliation(s)
- Elisabetta Scanferla
- Clinique des maladies mentales et de l'encéphale (CMME), GHU Paris Psychiatrie et neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, Paris, France
- Université de Paris, ED 450, Paris, Île-de-France, France
- Université Paris Nanterre, EA 4403, CLIPSYD, Paris, France
| | - Léonor Fasse
- Université de Paris, LPPS, EA 4057, Paris, Île-de-France, France
- Département de Soins de Support, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Philip Gorwood
- Clinique des maladies mentales et de l'encéphale (CMME), GHU Paris Psychiatrie et neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, Paris, France
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR 1266, Paris, France
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Aye AMM, Bai X, Borrow R, Bory S, Carlos J, Caugant DA, Chiou CS, Dai VTT, Dinleyici EC, Ghimire P, Handryastuti S, Heo JY, Jennison A, Kamiya H, Tonnii Sia L, Lucidarme J, Marshall H, Putri ND, Saha S, Shao Z, Sim JHC, Smith V, Taha MK, Van Thanh P, Thisyakorn U, Tshering K, Vázquez J, Veeraraghavan B, Yezli S, Zhu B. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect 2020; 81:698-711. [PMID: 32730999 DOI: 10.1016/j.jinf.2020.07.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.
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Affiliation(s)
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Vo Thi Trang Dai
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
| | | | - Hajime Kamiya
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Helen Marshall
- Robinson Research Institute and department of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Nina Dwi Putri
- Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Senjuti Saha
- Child Health Research Foundation, Mohammadpur, Dhaka1207, Bangladesh.
| | - Zhujun Shao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | | | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | | | - Phan Van Thanh
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Kinley Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Julio Vázquez
- National Reference Laboratory for Meningococci, Institute of Health Carlos III, Spain.
| | | | - Saber Yezli
- Global Center for Mass Gatherings Medicine, Saudi Arabia
| | - Bingqing Zhu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Opening the OPK Assay Gatekeeper: Harnessing Multi-Modal Protection by Pneumococcal Vaccines. Pathogens 2019; 8:pathogens8040203. [PMID: 31652741 PMCID: PMC6963391 DOI: 10.3390/pathogens8040203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal vaccine development is driven by the achievement of high activity in a single gatekeeper assay: the bacterial opsonophagocytic killing (OPK) assay. New evidence challenges the dogma that anti-capsular antibodies have only a single function that predicts success. The emerging concept of multi-modal protection presents an array of questions that are fundamental to adopting a new vaccine design process. If antibodies have hidden non-opsonic functions that are protective, should these be optimized for better vaccines? What would protein antigens add to protective activity? Are cellular immune functions additive to antibodies for success? Do different organs benefit from different modes of protection? Can vaccine activities beyond OPK protect the immunocompromised host? This commentary raises these issues at a time when capsule-only OPK assay-based vaccines are increasingly seen as a limiting strategy.
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15
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Şah İpek M. Neonatal Bacterial Meningitis. NEONATAL MEDICINE 2019. [DOI: 10.5772/intechopen.87118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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16
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Nandi A, Deolalikar AB, Bloom DE, Laxminarayan R. Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children. Ann N Y Acad Sci 2019; 1449:70-82. [PMID: 31180594 PMCID: PMC6852042 DOI: 10.1111/nyas.14127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
Haemophilus influenzae type b (Hib) affects 337,000 Indian children every year. A vaccine against Hib was introduced in 2011 as part of the pentavalent vaccine and scaled up nationwide. This study investigated the associations between Hib vaccination and child anthropometry, cognition, and schooling outcomes in India. We used longitudinal survey data and employed propensity score matching to control for observed systematic differences between children who reported receipt or nonreceipt of Hib vaccine before age 6 years (n = 1824). Z-scores of height-for-age (HAZ) and BMI-for-age (BMIZ), percentage scores of English, mathematics, reading, and Peabody Picture Vocabulary tests, and attained schooling grade of children were examined. Hib-vaccinated children had 0.25 higher HAZ, scored 4.09 percentage points (pp) higher on the English test and 4.78 pp higher on the mathematics test, and attained 0.16 more schooling grades than Hib-unvaccinated children at age 11-12 years. At age 14-15 years, they had 0.18 higher HAZ, scored 3.63 pp higher on the reading test and 3.22 pp higher on the mathematics test, and attained 0.15 more schooling grades than Hib-unvaccinated children. The findings indicate potential long-term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics and Policy, Washington, DC
| | - Anil B Deolalikar
- School of Public Policy and Department of Economics, University of California, Riverside, California
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics and Policy, New Delhi, India.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey
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Huo L, Fan Y, Jiang C, Gao J, Yin M, Wang H, Yang F, Cao Q. Clinical Features of and Risk Factors for Hydrocephalus in Childhood Bacterial Meningitis. J Child Neurol 2019; 34:11-16. [PMID: 30373442 DOI: 10.1177/0883073818799155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the clinical characteristics of and analyze the risk factors for hydrocephalus in children with bacterial meningitis. METHODS Retrospective study of a sample of children with bacterial meningitis seen on the pediatric service of Shengjing Hospital of China Medical University between January 1, 2010, and December 31, 2016. RESULTS Overall, 9.36% (25/267) of patients presented with hydrocephalus. Among patients with hydrocephalus, the age at onset of bacterial meningitis was usually <6 months, 15 patients had confirmed bacterial etiology, and 1 patient died. The most significant results of multivariate analysis for hydrocephalus were a rural living situation, altered level of consciousness, previous treatment with antibiotics, initial cerebrospinal fluid protein >2 g/L, C-reactive protein >100 mg/L, and dexamethasone use. CONCLUSIONS A severe clinical manifestation and significant laboratory index at admission are the most important predictors of hydrocephalus in children with bacterial meningitis.
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Affiliation(s)
- Liang Huo
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuying Fan
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunying Jiang
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Gao
- 2 Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meng Yin
- 3 Department of Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hua Wang
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fenghua Yang
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qingjun Cao
- 1 Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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18
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Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, Abd-Allah F, Abdela J, Abdelalim A, Adamu AA, Adib MG, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akseer N, Al-Raddadi RM, Alahdab F, Alene KA, Aljunid SM, AlMazroa MA, Altirkawi K, Alvis-Guzman N, Animut MD, Anjomshoa M, Ansha MG, Asghar RJ, Avokpaho EFGA, Awasthi A, Badali H, Barac A, Bärnighausen TW, Bassat Q, Bedi N, Belachew AB, Bhattacharyya K, Bhutta ZA, Bijani A, Butt ZA, Carvalho F, Castañeda-Orjuela CA, Chitheer A, Choi JYJ, Christopher DJ, Dang AK, Daryani A, Demoz GT, Djalalinia S, Do HP, Dubey M, Dubljanin E, Duken EE, El Sayed Zaki M, Elyazar IRF, Fakhim H, Fernandes E, Fischer F, Fukumoto T, Ganji M, Gebre AK, Gebremeskel A, Gessner BD, Gopalani SV, Guo Y, Gupta R, Hailu GB, Haj-Mirzaian A, Hamidi S, Hay SI, Henok A, Irvani SSN, Jha RP, JÜRISSON M, Kahsay A, Karami M, Karch A, Kasaeian A, Kassa GM, Kassa TDD, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang YH, Khubchandani J, Kimokoti RW, Kisa A, Lami FH, Levi M, Li S, Loy CT, Majdan M, Majeed A, Mantovani LG, Martins-Melo FR, Mcalinden C, Mehta V, Melese A, Memish ZA, Mengistu DT, Mengistu G, Mestrovic T, Mezgebe HB, Miazgowski B, Milosevic B, Mokdad AH, Monasta L, Moradi G, Moraga P, Mousavi SM, Mueller UO, Murthy S, Mustafa G, Naghavi M, Naheed A, Naik G, Newton CRJ, Nirayo YL, Nixon MR, Ofori-Asenso R, Ogbo FA, Olagunju AT, Olagunju TO, Olusanya BO, Ortiz JR, Owolabi MO, Patel S, Pinilla-Monsalve GD, Postma MJ, Qorbani M, Rafiei A, Rahimi-Movaghar V, Reiner RC, Renzaho AM, Rezai MS, Roba KT, Ronfani L, Roshandel G, Rostami A, Safari H, Safari S, Safiri S, Sagar R, Samy AM, Santric Milicevic MM, Sartorius B, Sarvi S, Sawhney M, Saxena S, Shafieesabet A, Shaikh MA, Sharif M, Shigematsu M, Si S, Skiadaresi E, Smith M, Somayaji R, Sufiyan MB, Tawye NY, Temsah MH, Tortajada-Girbés M, Tran BX, Tran KB, Ukwaja KN, Ullah I, Vujcic IS, Wagnew FS, Waheed Y, Weldegwergs KG, Winkler AS, Wiysonge CS, Wiyeh AB, Wyper GM, Yimer EM, Yonemoto N, Zaidi Z, Zenebe ZM, Feigin VL, Vos T, Murray CJL. Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17:1061-1082. [PMID: 30507391 PMCID: PMC6234314 DOI: 10.1016/s1474-4422(18)30387-9] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes. METHODS The Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education. FINDINGS Global meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426-458 514) to 318 400 (265 218-408 705). Incident cases globally increased from 2·50 million (95% UI 2·19-2·91) in 1990 to 2·82 million (2·46-3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates and incidence rates were found in the peri-Sahelian countries that comprise the African meningitis belt, with six of the ten countries with the largest number of cases and deaths being located within this region. Haemophilus influenzae type b was the most common cause of incident meningitis in 1990, at 780 070 cases (95% UI 613 585-978 219) globally, but decreased the most (-49·1%) to become the least common cause in 2016, with 397 297 cases (291 076-533 662). Meningococcus was the leading cause of meningitis mortality in 1990 (192 833 deaths [95% UI 153 358-221 503] globally), whereas other meningitis was the leading cause for both deaths (136 423 [112 682-178 022]) and incident cases (1·25 million [1·06-1·49]) in 2016. Pneumococcus caused the largest number of YLDs (634 458 [444 787-839 749]) in 2016, owing to its more severe long-term effects on survivors. Globally in 2016, 1·48 million (1·04-1·96) YLDs were due to meningitis compared with 21·87 million (18·20-28·28) DALYs, indicating that the contribution of mortality to meningitis burden is far greater than the contribution of disabling outcomes. INTERPRETATION Meningitis burden remains high and progress lags substantially behind that of other vaccine-preventable diseases. Particular attention should be given to developing vaccines with broader coverage against the causes of meningitis, making these vaccines affordable in the most affected countries, improving vaccine uptake, improving access to low-cost diagnostics and therapeutics, and improving support for disabled survivors. Substantial uncertainty remains around pathogenic causes and risk factors for meningitis. Ongoing, active cause-specific surveillance of meningitis is crucial to continue and to improve monitoring of meningitis burdens and trends throughout the world. FUNDING Bill & Melinda Gates Foundation.
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20
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Govender I, Steyn C, Maricowitz G, Clark CC, Tjale MC. A primary care physician’s approach to a child with meningitis. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2017.1394610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- I Govender
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - C Steyn
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - G Maricowitz
- Department of Family Medicine, University of Limpopo, Polokwane, South Africa
| | - CC Clark
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - MC Tjale
- Department of Family Medicine, University of Limpopo, Polokwane, South Africa
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Alcock KJ, Abubakar A, Newton CR, Holding P. The effects of prenatal HIV exposure on language functioning in Kenyan children: establishing an evaluative framework. BMC Res Notes 2016; 9:463. [PMID: 27733206 PMCID: PMC5062875 DOI: 10.1186/s13104-016-2264-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV infection has been associated with impaired language development in prenatally exposed children. Although most of the burden of HIV occurs in sub-Saharan Africa, there have not been any comprehensive studies of HIV exposure on multiple aspects of language development using instruments appropriate for the population. METHODS We compared language development in children exposed to HIV in utero to community controls (N = 262, 8-30 months) in rural Kenya, using locally adapted and validated communicative development inventories. RESULTS The mean score of the younger HIV-exposed uninfected infants (8-15 months) was not significantly below that of the controls; however older HIV-exposed uninfected children had significantly poorer language scores, with HIV positive children scoring more poorly than community controls, on several measures. CONCLUSIONS Our preliminary data indicates that HIV infection is associated with impaired early language development, and that the methodology developed would be responsive to a more detailed investigation of the variability in outcome amongst children exposed to HIV, irrespective of their infection status.
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Affiliation(s)
- K J Alcock
- Department of Psychology, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK.
| | - Amina Abubakar
- Department of Psychology, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK.,Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R Newton
- Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Penny Holding
- Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi, Kenya.,Saving Brains Platform Team, Mombasa, Kenya
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Atkinson J, Denmark T, Marshall J, Mummery C, Woll B. Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test. Arch Clin Neuropsychol 2015; 30:694-711. [DOI: 10.1093/arclin/acv042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 11/13/2022] Open
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White C, Edwards M, Brown J, Bell J. The impact of recreational MDMA 'ecstasy' use on global form processing. J Psychopharmacol 2014; 28:1018-29. [PMID: 25142406 DOI: 10.1177/0269881114546709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The ability to integrate local orientation information into a global form percept was investigated in long-term ecstasy users. Evidence suggests that ecstasy disrupts the serotonin system, with the visual areas of the brain being particularly susceptible. Previous research has found altered orientation processing in the primary visual area (V1) of users, thought to be due to disrupted serotonin-mediated lateral inhibition. The current study aimed to investigate whether orientation deficits extend to higher visual areas involved in global form processing. Forty-five participants completed a psychophysical (Glass pattern) study allowing an investigation into the mechanisms underlying global form processing and sensitivity to changes in the offset of the stimuli (jitter). A subgroup of polydrug-ecstasy users (n=6) with high ecstasy use had significantly higher thresholds for the detection of Glass patterns than controls (n=21, p=0.039) after Bonferroni correction. There was also a significant interaction between jitter level and drug-group, with polydrug-ecstasy users showing reduced sensitivity to alterations in jitter level (p=0.003). These results extend previous research, suggesting disrupted global form processing and reduced sensitivity to orientation jitter with ecstasy use. Further research is needed to investigate this finding in a larger sample of heavy ecstasy users and to differentiate the effects of other drugs.
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Affiliation(s)
- Claire White
- The Australian National University, Canberra, ACT, Australia
| | - Mark Edwards
- The Australian National University, Canberra, ACT, Australia
| | - John Brown
- The Australian National University, Canberra, ACT, Australia
| | - Jason Bell
- The University of Western Australia, Perth, WA, Australia
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Alterations to global but not local motion processing in long-term ecstasy (MDMA) users. Psychopharmacology (Berl) 2014; 231:2611-22. [PMID: 24441968 DOI: 10.1007/s00213-014-3431-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE Growing evidence indicates that the main psychoactive ingredient in the illegal drug "ecstasy" (methylendioxymethamphetamine) causes reduced activity in the serotonin and gamma-aminobutyric acid (GABA) systems in humans. On the basis of substantial serotonin input to the occipital lobe, recent research investigated visual processing in long-term users and found a larger magnitude of the tilt aftereffect, interpreted to reflect broadened orientation tuning bandwidths. Further research found higher orientation discrimination thresholds and reduced long-range interactions in the primary visual area of ecstasy users. OBJECTIVES The aim of the present research was to investigate whether serotonin-mediated V1 visual processing deficits in ecstasy users extend to motion processing mechanisms. METHOD Forty-five participants (21 controls, 24 drug users) completed two psychophysical studies: A direction discrimination study directly measured local motion processing in V1, while a motion coherence task tested global motion processing in area V5/MT. RESULTS "Primary" ecstasy users (n = 18), those without substantial polydrug use, had significantly lower global motion thresholds than controls [p = 0.027, Cohen's d = 0.78 (large)], indicating increased sensitivity to global motion stimuli, but no difference in local motion processing (p = 0.365). CONCLUSION These results extend on previous research investigating the long-term effects of illicit drugs on visual processing. Two possible explanations are explored: defuse attentional processes may be facilitating spatial pooling of motion signals in users. Alternatively, it may be that a GABA-mediated disruption to V5/MT processing is reducing spatial suppression and therefore improving global motion perception in ecstasy users.
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Suppiej A, Cainelli E, Casara G, Cappellari A, Nosadini M, Sartori S. Long-term neurocognitive outcome and quality of life in pediatric acute disseminated encephalomyelitis. Pediatr Neurol 2014; 50:363-7. [PMID: 24630282 DOI: 10.1016/j.pediatrneurol.2013.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis is an inflammatory-demyelinating disorder of the central nervous system usually with a monophasic course and a favorable neurological outcome. Long-term neurocognitive sequelae and quality of life have not yet been fully investigated. AIM To examine neurocognitive outcome and quality of life in pediatric monophasic acute disseminated encephalomyelitis. METHODS Of the 36 patients diagnosed with acute disseminated encephalomyelitis at our institution, six were lost to follow-up and eight relapsed (two with multiphasic forms and six with multiple sclerosis). The outcome of the 22 remaining patients was evaluated using four subscales of the Wechsler Intelligence Scales for estimation of IQ, a battery of neuropsychological tests, and semistructured and PedsQL questionnaires for quality of life. The effect of age at onset, neuroradiological recovery, and time elapsed from the acute event on outcome was also investigated. RESULTS Estimated IQ, neuropsychological mean group scores, and quality of life at follow-up were within the normal range, but 23% of the patients had pathological scores in various neuropsychological functions, among which attention was the most clearly affected. The neuroradiological recovery was not correlated with the result of the neuropsychological tests. Age at onset correlated with linguistic skills, whereas the time elapsed from the acute event had a significant effect on attention tasks: scores were worse in the group of patients with a follow-up shorter than 7 years. CONCLUSION Our results suggest that pediatric monophasic acute disseminated encephalomyelitis has a favorable neurocognitive outcome. Patients with longer follow-up had a better outcome, suggesting a neurocognitive course that is different from that of multiple sclerosis and a potential for long-term recovery of affected functions.
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Affiliation(s)
- Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy.
| | - Elisa Cainelli
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy; Lifespan Cognitive Neuroscience Laboratory, Department of General Psychology, University of Padua, Padua, Italy
| | - Giulia Casara
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy
| | - Ambra Cappellari
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy
| | - Margherita Nosadini
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy
| | - Stefano Sartori
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy
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Altered visual perception in long-term ecstasy (MDMA) users. Psychopharmacology (Berl) 2013; 229:155-65. [PMID: 23609769 DOI: 10.1007/s00213-013-3094-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE The present study investigated the long-term consequences of ecstasy use on visual processes thought to reflect serotonergic functions in the occipital lobe. Evidence indicates that the main psychoactive ingredient in ecstasy (methylendioxymethamphetamine) causes long-term changes to the serotonin system in human users. Previous research has found that amphetamine-abstinent ecstasy users have disrupted visual processing in the occipital lobe which relies on serotonin, with researchers concluding that ecstasy broadens orientation tuning bandwidths. However, other processes may have accounted for these results. OBJECTIVES The aim of the present research was to determine if amphetamine-abstinent ecstasy users have changes in occipital lobe functioning, as revealed by two studies: a masking study that directly measured the width of orientation tuning bandwidths and a contour integration task that measured the strength of long-range connections in the visual cortex of drug users compared to controls. METHOD Participants were compared on the width of orientation tuning bandwidths (26 controls, 12 ecstasy users, 10 ecstasy + amphetamine users) and the strength of long-range connections (38 controls, 15 ecstasy user, 12 ecstasy + amphetamine users) in the occipital lobe. RESULTS Amphetamine-abstinent ecstasy users had significantly broader orientation tuning bandwidths than controls and significantly lower contour detection thresholds (CDTs), indicating worse performance on the task, than both controls and ecstasy + amphetamine users. CONCLUSION These results extend on previous research, which is consistent with the proposal that ecstasy may damage the serotonin system, resulting in behavioral changes on tests of visual perception processes which are thought to reflect serotonergic functions in the occipital lobe.
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Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children. Crit Care Med 2013; 41:1094-103. [PMID: 23385103 DOI: 10.1097/ccm.0b013e318275d032] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess short-term neuropsychological function and academic performance in school children following admission to intensive care and to explore the role of critical neurologic and systemic infection. DESIGN A prospective observational case-control study. SETTING Two PICUs. SUBJECTS A consecutive sample of 88 children aged 5-16 years (median age=10.00, interquartile range=6.00-13.00) who were admitted to intensive care between 2007 and 2010 with meningoencephalitis, septic illness, or other critical illnesses. They were assessed 3 to 6 months following discharge, and their performance was compared with that of 100 healthy controls. Patients were without prior neurologic or neurodevelopmental disorder. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data encompassing demographic and critical illness details were obtained, and children were assessed using tests of intellectual function, memory, and attention. Questionnaires addressing academic performance were returned by teachers. After adjusting for covariates, the children admitted to PICUs significantly underperformed on neuropsychological measures in comparison to healthy controls (p<0.02). Teachers deemed more children admitted to PICUs than controls as performing educationally worse and having problems with school work (ps=0.001), as well as performing below average on aspects of executive function and attention (ps<0.04). Analysis of the effect of illness type on outcome revealed that aspects of neuropsychological function, such as memory function, and teacher-rated academic performance were most reduced in children with meningoencephalitis and septic illness. In the PICU group, multivariable linear regression revealed that worse performance on a composite score of neuropsychologic impairment was more prevalent when children were younger, from a lower social class, and had experienced seizures during their admission (ps<0.02). CONCLUSIONS Admission to intensive care is followed by deficits in neuropsychologic performance and educational difficulties, with more severe difficulties noted following meningoencephalitis and septic illness. These results highlight the importance of future studies on cognition and educational outcome incorporating type of illness as a moderating factor.
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Namani S, Milenković Z, Koci B. A prospective study of risk factors for neurological complications in childhood bacterial meningitis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2012.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Namani S, Milenković Z, Koci B. A prospective study of risk factors for neurological complications in childhood bacterial meningitis. J Pediatr (Rio J) 2013; 89:256-62. [PMID: 23664199 DOI: 10.1016/j.jped.2012.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 10/31/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To prospectively analyze the prognostic factors for neurological complications of childhood bacterial meningitis. METHODS This prospective study enrolled 77 children from 1 month until 16 years of age, treated for bacterial meningitis during the period of January 1, 2009 through December 31, 2010. 16 relevant predictors were chosen to analyze their association with the incidence of neurological complications. p-values < 0.05 were considered statistically significant. RESULTS Of the 77 children treated for bacterial meningitis, 33 patients developed neurological complications (43%), and two children died (2.6%). The etiology of bacterial meningitis cases was proven in 57/77 (74%) cases: 32 meningococci, eight pneumococci, six Gram-negative bacilli, five H. influenzae, five staphylococci, and one S. viridans isolates were found. Factors found to be associated with increased risk of development of neurological complications were age < 12 months, altered mental status, seizures prior to admission, initial therapy with two antibiotics, dexamethasone use, presence of focal neurological deficit on admission and increased proteins in cerebrospinal fluid (CSF) (p < 0.05). Initial pleocytosis > 5,000 cells/mm(3), pleocytosis > 5,000 cells/mm(3) after 48 hours, CSF/blood glucose ratio < 0.20, female gender, previous treatment with antibiotics, community-acquired infection, duration of illness > 48 hours, presence of comorbidity, and primary focus of infection were not associated with increased risk for the development of neurological complications. CONCLUSION Age < 12 months and severity of clinical presentation at admission were identified as the strongest predictors of neurological complications and may be of value in selecting patients for more intensive care and treatment.
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Affiliation(s)
- Sadie Namani
- Infectious Diseases Clinic, University Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Kosovo.
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On Nontraumatic Brain Injury in Pediatric Critical Illness, Neuropsychologic Short-Term Outcome, Delirium, and Resilience*. Crit Care Med 2013; 41:1160-1. [DOI: 10.1097/ccm.0b013e31827bf658] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allman C, Scott RB. Neuropsychological sequelae following pediatric stroke: A nonlinear model of age at lesion effects. Child Neuropsychol 2013; 19:97-107. [PMID: 22145793 DOI: 10.1080/09297049.2011.639756] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Prats JAGG, Gaspar AJ, Ribeiro ABG, Paula GDD, Boas LVDSPV, Sá FPD. Revisão sistemática do uso da dexametasona como terapia adjuvante na meningite bacteriana em crianças. REVISTA PAULISTA DE PEDIATRIA 2012. [DOI: 10.1590/s0103-05822012000400018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar a melhor evidência disponível nos últimos 15 anos com relação aos benefícios da terapia adjuvante com dexametasona na meningite bacteriana em população pediátrica. FONTES DE DADOS: Das bases de dados Medline, Lilacs e SciELO, foram analisados ensaios clínicos randomizados de 1996 a 2011, os quais comparavam a dexametasona ao placebo e/ou a outra terapia adjuvante em pacientes com meningite bacteriana diagnosticada laboratorialmente por critérios quimiocitológicos e/ou bacteriológicos, na faixa etária de 29 dias aos 18 anos. Os desfechos avaliados foram mortalidade e ocorrência de sequelas neurológicas e/ou auditivas. Foram excluídos estudos relacionados à meningite tuberculosa. SÍNTESE DOS DADOS: Com os critérios utilizados, foram identificadas cinco publicações correspondentes a quatro protocolos de estudo. Nenhum dos estudos mostrou diferenças entre a dexametasona e o placebo para os desfechos avaliados. Os estudos analisados tiveram alta qualidade (escore de Jadad et al=5). CONCLUSÕES: As evidências encontradas na literatura são insuficientes para indicar de forma rotineira o uso da dexametasona como terapia adjuvante para redução de mortalidade, perda auditiva e sequelas neurológicas em pacientes pediátricos com meningite bacteriana não tuberculosa.
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Kihara M, de Haan M, Were EO, Garrashi HH, Neville BGR, Newton CRJC. Cognitive deficits following exposure to pneumococcal meningitis: an event-related potential study. BMC Infect Dis 2012; 12:79. [PMID: 22462525 PMCID: PMC3347992 DOI: 10.1186/1471-2334-12-79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 03/31/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pneumococcal meningitis (PM) is a severe and life-threatening disease that is associated with cognitive impairment including learning difficulties, cognitive slowness, short-term memory deficits and poor academic performance. There are limited data on cognitive outcomes following exposure to PM from Africa mainly due to lack of culturally appropriate tools. We report cognitive processes of exposed children as measured by auditory and visual event-related potentials. METHODS Sixty-five children (32 male, mean 8.4 years, SD 3.0 years) aged between 4-15 years with a history of PM and an age-matched control group of 93 children (46 male; mean 8.4 years, SD 2.7 years) were recruited from a well-demarcated study area in Kilifi. In the present study, both baseline to peak and peak-to-peak amplitude differences are reported. RESULTS Children with a history of pneumococcal meningitis had significantly longer auditory P1 and P3a latencies and smaller P1 amplitudes compared to unexposed children. In the visual paradigm, children with PM seemingly lacked a novelty P3a component around 350 ms where control children had a maximum, and showed a lack of stimulus differentiation at Nc. Further, children with exposure to PM had smaller peak to peak amplitude (N2-P1) compared to unexposed children. CONCLUSION The results suggest that children with a history of PM process novelty differently than do unexposed children, with slower latencies and reduced or absent components. This pattern suggests poorer auditory attention and/or cognitive slowness and poorer visual attention orienting, possibly due to disruption in the functions of the lateral prefrontal and superior temporal cortices. ERPs may be useful for assessment of the development of perceptual-cognitive functions in post brain-injury in African children by providing an alternate way of assessing cognitive development in patient groups for whom more typical standardized neuropsychological assessments are unavailable.
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Affiliation(s)
- Michael Kihara
- The Centre for Geographical Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Michelle de Haan
- Developmental Cognitive Neuroscience Unit, University College London Institute of Child Health, London, UK
| | - Eugene O Were
- The Centre for Geographical Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Department of Paediatrics, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Harrun H Garrashi
- The Centre for Geographical Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
| | - Brian GR Neville
- Neurosciences Unit, University College London Institute of Child Health, The Wolfson Centre, London, UK
| | - Charles RJC Newton
- The Centre for Geographical Medicine Research (Coast), Kenya Medical Research Institute, Kilifi, Kenya
- Neurosciences Unit, University College London Institute of Child Health, The Wolfson Centre, London, UK
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Abstract
Bacterial meningitis causes persisting neurofunctional sequelae. Theoccurrence of apoptotic cell death in the hippocampal subgranular zone of the dentate gyrus characterizes the disease in patients and relates to deficits in learning and memory in corresponding experimental models. Here, we investigated why neurogenesis fails to regenerate the damage in the hippocampus associated with the persistence of neurofunctional deficits. In an infant rat model of bacterial meningitis, the capacity of hippocampal-derived cells to multiply and form neurospheres was significantly impaired comparedto that in uninfected littermates. In an in vitro model of differentiating hippocampal cells, challenges characteristic of bacterial meningitis (i.e. bacterial components, tumor necrosis factor [20 ng/mL], or growth factor deprivation) caused significantly more apoptosis in stem/progenitor cells and immature neurons than in mature neurons. These results demonstrate that bacterial meningitis injures hippocampal stem and progenitor cells, a finding that may explain the persistence of neurofunctional deficits after bacterial meningitis.
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Survivors of septic shock caused by Neisseria meningitidis in childhood: psychosocial outcomes in young adulthood. Pediatr Crit Care Med 2011; 12:e302-9. [PMID: 21499180 DOI: 10.1097/pcc.0b013e3182192d7f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate long-term psychosocial outcomes in young adults who survived septic shock caused by Neisseria meningitidis (meningococcal septic shock) during childhood. DESIGN A cross-sectional study. SETTING The psychological investigation took place in the department of Child and Adolescent Psychiatry of the Erasmus MC-Sophia Children's Hospital. PATIENTS All consecutive surviving patients with meningococcal septic shock requiring intensive care treatment at the pediatric intensive care unit between 1988 and 2001. INTERVENTION To explore biographical characteristics (such as living conditions, educational, occupational, and marital status) and illness-related physical or social consequences a structured interview was used. To assess intellectual functioning the Groninger Intelligence Test 2 was used and to assess behavioral/emotional problems, the Adult Self-Report was used. MEASUREMENTS AND MAIN RESULTS Fifty-eight of 83 eligible septic shock survivors were evaluated (response rate: 70%). The patients were 16-31 yrs old at time of follow-up (median age: 21 yrs old). These patients had had meningococcal septic shock before 18 yrs of age. Median follow-up interval was 13 yrs, with a range of 4 to 16 yrs. For the vast majority of meningococcal septic shock patients, outcomes on biographical characteristics, intellectual functioning, and levels of behavioral/emotional problems were comparable to those of reference groups. A minority (5% to 20%) still report illness-related physical or social consequences, behavioral and emotional problems, and lower intellectual functioning. CONCLUSIONS Despite favorable outcomes for the majority of meningococcal septic shock patients in the long term, an important minority (5% to 20%) still struggles with ongoing problems as to behavioral/emotional problems, intellectual functioning, biographical characteristics, and illness-related physical or social consequences.
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Prognostic factors related to sequelae in childhood bacterial meningitis: data from a Greek meningitis registry. BMC Infect Dis 2011; 11:214. [PMID: 21827712 PMCID: PMC3166933 DOI: 10.1186/1471-2334-11-214] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacterial meningitis (BM) is a life-threatening disease, often related with serious complications and sequelae. Infants and children who survive bacterial meningitis often suffer neurological and other sequelae. METHODS A total of 2,477 patients aged 1 month to 14 years old hospitalized in a Children's Hospital in Greece diagnosed with acute bacterial meningitis were collected through a Meningitis Registry, from 1974 to 2005. Clinical, laboratory and other parameters (sex, age, pathogen, duration of symptoms before and after admission) were evaluated through univariate and multivariate analysis with regard to sequelae. Analysis of acute complications were also studied but not included in the final model. RESULTS The rate of acute complications (arthritis and/or subdural effusion) was estimated at 6.8% (152 out of 2,251 patients, 95%CI 5.8-7.9) while the rate of sequelae (severe hearing loss, ventriculitis, hydrocephalus or seizure disorder) among survivors was estimated at 3.3% (73 out of 2,207 patients, 95%CI 2.6-4.2). Risk factors on admission associated with sequelae included seizures, absence of hemorrhagic rash, low CSF glucose, high CSF protein and the etiology of meningitis. A combination of significant prognostic factors including presence of seizures, low CSF glucose, high CSF protein, positive blood culture and absence of petechiae on admission presented an absolute risk of sequelae of 41.7% (95%CI 15.2-72.3). CONCLUSIONS A combination of prognostic factors of sequelae in childhood BM may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.
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Anderson V, Spencer-Smith M, Wood A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain 2011; 134:2197-221. [PMID: 21784775 DOI: 10.1093/brain/awr103] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Vicki Anderson
- Department of Psychology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
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Spencer-Smith M, Anderson P, Jacobs R, Coleman L, Long B, Anderson V. Does Timing of Brain Lesion Have an Impact on Children's Attention? Dev Neuropsychol 2011; 36:353-66. [DOI: 10.1080/87565641.2010.549983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vermunt LCAC, Buysse CMP, Aarsen FK, Catsman-Berrevoets CE, Duivenvoorden HJ, Joosten KFM, Hazelzet JA, Verhulst FC, Utens EMWJ. Long-term cognitive functioning in children and adolescents who survived septic shock caused by Neisseria meningitidis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 48:195-208. [DOI: 10.1348/014466508x391094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
The clinical outcome of central nervous system infection is determined by the characteristics of the pathogen and the brain's response to the invading bacteria. How infection leads to brain injury remains unresolved. An impediment to progress is the complexity of pathophysiologic processes. Some of the mechanisms involved have been identified in experimental models, providing insights into the molecular basis of brain injury and regeneration, and hinting at targets for therapy. Adjuvant therapies have been proposed. Interventions that protect the brain are evaluated for their potential to preserve neuro-integrative functions in long-term survivors of bacterial meningitis. This article summarizes current studies evaluating pharmacologic interventions in experimental models of bacterial meningitis and discusses how the knowledge gathered could translate into more effective therapies.
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Abstract
BACKGROUND While many children with brain conditions present with cognitive, behavioural, emotional, academic and social impairments, other children recover with seemingly few impairments. Animal studies and preliminary child studies have identified timing of brain lesion as a key predictor in determining functional outcome following early brain lesions. REVIEW This research suggests that knowledge of healthy developmental processes in brain structure and function is essential for better understanding functional recovery and outcome in children with brain lesions. This review paper aims to equip researchers with current knowledge of key principles of developmental processes in brain structure and function. Timetables for development of the prefrontal cortex (PFC), a brain region particularly vulnerable to lesions due to its protracted developmental course, are examined. In addition, timetables for development of executive skills, which emerge in childhood and have a prolonged developmental course that parallels development of the PFC, are also discussed. CONCLUSIONS Equipped with this knowledge, researchers are now in a better position to understand functional recovery and outcome in children with brain conditions.
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Affiliation(s)
- Megan Spencer-Smith
- Critical Care and Neurosciences, Murdoch Childrens Research Institute, Royal Children's Hospital, FlemingtonRoad, Parkville, VIC 3054, Australia.
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Deery B, Anderson V, Jacobs R, Neale J, Kornberg A. Childhood MS and ADEM: Investigation and Comparison of Neurocognitive Features in Children. Dev Neuropsychol 2010; 35:506-21. [DOI: 10.1080/87565641.2010.494921] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Jonge RCJ, van Furth AM, Wassenaar M, Gemke RJBJ, Terwee CB. Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies. BMC Infect Dis 2010; 10:232. [PMID: 20684796 PMCID: PMC2921388 DOI: 10.1186/1471-2334-10-232] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 08/05/2010] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. Methods A search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized. Results Of the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints >48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count. Conclusions Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studies.
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Affiliation(s)
- Rogier C J de Jonge
- VU University Medical Center, Department of Pediatrics and Infectious Diseases, Amsterdam, The Netherlands.
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Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2010; 10:317-28. [PMID: 20417414 DOI: 10.1016/s1473-3099(10)70048-7] [Citation(s) in RCA: 379] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Few data sources are available to assess the global and regional risk of sequelae from bacterial meningitis. We aimed to estimate the risks of major and minor sequelae caused by bacterial meningitis, estimate the distribution of the different types of sequelae, and compare risk by region and income. We systematically reviewed published papers from 1980 to 2008. Standard global burden of disease categories (cognitive deficit, bilateral hearing loss, motor deficit, seizures, visual impairment, hydrocephalus) were labelled as major sequelae. Less severe, minor sequelae (behavioural problems, learning difficulties, unilateral hearing loss, hypotonia, diplopia), and multiple impairments were also included. 132 papers were selected for inclusion. The median (IQR) risk of at least one major or minor sequela after hospital discharge was 19.9% (12.3-35.3%). The risk of at least one major sequela was 12.8% (7.2-21.1%) and of at least one minor sequela was 8.6% (4.4-15.3%). The median (IQR) risk of at least one major sequela was 24.7% (16.2-35.3%) in pneumococcal meningitis; 9.5% (7.1-15.3%) in Haemophilus influenzae type b (Hib), and 7.2% (4.3-11.2%) in meningococcal meningitis. The most common major sequela was hearing loss (33.9%), and 19.7% had multiple impairments. In the random-effects meta-analysis, all-cause risk of a major sequela was twice as high in the African (pooled risk estimate 25.1% [95% CI 18.9-32.0%]) and southeast Asian regions (21.6% [95% CI 13.1-31.5%]) as in the European region (9.4% [95% CI 7.0-12.3%]; overall I(2)=89.5%, p<0.0001). Risks of long-term disabling sequelae were highest in low-income countries, where the burden of bacterial meningitis is greatest. Most reported sequelae could have been averted by vaccination with Hib, pneumococcal, and meningococcal vaccines.
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Affiliation(s)
- Karen Edmond
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Kushnir J, Sadeh A. Childhood fears, neurobehavioral functioning and behavior problems in school-age children. Child Psychiatry Hum Dev 2010; 41:88-97. [PMID: 19636700 DOI: 10.1007/s10578-009-0154-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/19/2009] [Indexed: 11/25/2022]
Abstract
The objective is to examine underlying associations between childhood fears, behavior problems and neurobehavioral functioning (NBF) in school-age children. Healthy, regular school children (N = 135), from second, fourth and sixth grade classes were assessed. Data regarding children's fears and behavioral problems were obtained with the Revised Fear Survey Schedule for Children, the Child Behavior Checklist, and NBF was assessed using a computerized neurobehavioral evaluation system. Significant correlations between childhood fears and NBF measures and somatic complaints were found. Children who reported higher levels of fears demonstrated lower working memory span (r = 0.24, p < 0.05), lower motor speed (r = -0.23, p < 0.05), and had more somatic complaints (r = 0.20, p < 0.05). Furthermore, younger children reported less fears than older ones and girls reported more fears than boys. These results highlight significant association between childhood fears, NBF and behavior problems in a non-clinical group children. Lower working memory span is an important component of executive control that may be an underlying factor in fears and anxiety in children.
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Affiliation(s)
- Jonathan Kushnir
- The Adler Center for Research in Child Development and Psychopathology, Department of Psychology, Tel-Aviv University, Ramat Aviv, 69978, Israel.
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Guilbert J, Levy C, Cohen R, Delacourt C, Renolleau S, Flamant C. Late and ultra late onset Streptococcus B meningitis: clinical and bacteriological data over 6 years in France. Acta Paediatr 2010; 99:47-51. [PMID: 20002014 DOI: 10.1111/j.1651-2227.2009.01510.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Group B Streptococcus (GBS) is one of the leading causes of sepsis and meningitis in newborn. The objective of this study was to describe the characteristics of GBS meningitis in children aged between 7 and 89 days (late onset disease - LOD group) and to compare them with children aged more than 3 months (ultra late onset disease - ULOD group). METHODS Clinical and biological data were gathered by ACTIV/GPIP (a nationwide active surveillance network). The study population included 242 children hospitalized between 2001 and 2006 for GBS meningitis (220 in the LOD group and 22 in the ULOD group). RESULTS Univariate analysis revealed that gestational age (GA) was significantly lower in the ULOD group as compared with the LOD group (respectively 35.6 weeks vs. 37.9 weeks, p = 0.002). Prevalence of early preterm birth (before the 32nd week GA) was significantly higher in the ULOD group than in the LOD group (32% vs. 7%, p = 0.002). No significant difference was found between the two groups for biological characteristics of lumbar puncture, GBS serotypes, complications and survival rate. CONCLUSION These data suggest that LOD and ULOD would be the same clinical and bacteriological entity, except for prematurity, which seems significantly associated with ULOD.
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Affiliation(s)
- J Guilbert
- Department of Paediatric Intensive Care Unit, Trousseau's Hospital, Paris, France.
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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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Ritchi L, Jennekens-Schinkel A, van Schooneveld M, Koomen I, Geenen R. Behaviour is not really at risk after surviving meningitis in childhood. Acta Paediatr 2008; 97:438-41. [PMID: 18307551 DOI: 10.1111/j.1651-2227.2008.00682.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine behaviour problems, personality, self-perceived competence and academic deficits in children who had recovered from non-Haemophilus influenzae type b (Hib) bacterial meningitis (BM) without obvious medical sequelae. METHODS Assessments in 182 children, mean age 10 (range 5-14) years, 4-10 years after surviving meningitis, were compared to scores of norm reference groups. RESULTS More children were estimated to have academic deficits (27%) than behaviour problems as perceived by the parents (9%). The mean deviation from normal was absent to moderate on behaviour problems, personality variables and self-perceived competence. CONCLUSION Children who survived non-Hib BM without severe medical sequelae hardly differ from normal children with respect to personality and self-perceived competence. A small proportion deviates from normal in behaviour problems.
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Affiliation(s)
- Lieneke Ritchi
- Sector of Neuropsychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Hooper L, Williams WH, Sarah EW, Chua KC. Caregiver distress, coping and parenting styles in cases of childhood encephalitis. Neuropsychol Rehabil 2007; 17:621-37. [PMID: 17676538 DOI: 10.1080/09602010601137054] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study presents an exploration of the impact of childhood encephalitis on parental mood, coping and disciplinary strategies. Thirty six parents of children aged between 10 and 17 years were recruited. They were split into groups of recent and remote cases (within or beyond 7 years). Group comparison revealed that neurobehavioural consequences of childhood encephalitis appear to persist over time. Higher levels of behavioural symptoms consistent with dysexecutive disorder were associated with greater parental distress. Parents remain distressed despite reporting proactive profiles of coping. There was an indication that severity of dysexecutive disorder was asscociated with less use of proactive parental management strategies. Support for parents, in particular focused on effective management of dysexecutive problems, is recommended.
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Affiliation(s)
- Lucy Hooper
- Centre for Clinical Neuropsychology Research, School of Psychology, University of Exeter, UK.
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Abstract
OBJECTIVE To study the long-term neurological and developmental outcome and the clinical and laboratory predictors of sequelae in children with acute bacterial meningitis (ABM). METHODS Detailed clinical and demographic data was retrieved from the medical records of study children. Subsequently they were followed up for a minimum of 12 months after discharge for development, neurological and hearing assessment. All sequelae were identified and divided into minor or major. For analysis data was divided into 2 groups those with sequelae and without sequelae at follow-up. Statistical analysis was done using SPSS version 10.00 and Epi Info version 2000. RESULTS 61 boys and 19 girls, a mean age of 31.4 +/= 41.9 months at the time of ABM, were included in the study. Of these 62.5% children were infants. Mean age at follow-up was 58.6 +/= 47.2 months. Sequelae were observed in 32 (40%) children (8 (10%) minor and 24 (30%) major). Mean social quotient at follow-up was 92.8 +/= 32.6. Developmentally 22 (37.9%) children were normal and 20 (34.5%) had global delay. Seizures (P=0.015), cranial nerve palsy (P=0.0065), abnormal deep tendon reflexes (P=0.002), Glasgow coma scale score (GCS) < 8 (P = 0.044) at admission, a CSF culture positive for bacteria and abnormal findings on ultrasonography or computed tomography of head at admission had significant association with sequelae at follow-up. All children (7/7) who had infarct on CT scan (P=0.001) and 12 (80%) of 15 patients who had hydrocephalus (OR - 9.0, 95% CI - 2.03-45.6, P=0.001) diagnosed on CT scan developed severe sequelae. On multiple regressions GCS score <8, presence of cranial nerve palsy and abnormal deep tendon reflexes were independent predictors of sequelae. CONCLUSION Neurological and audiological sequelae and global developmental delay may be seen in about one third of survivors of bacterial meningitis. GCS score <8, presence of infarct or cranial nerve palsy, or hydrocephalous on CT/ ultrasound at admission may help in identification of children most likely to need long term follow up and rehabilitation.
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Affiliation(s)
- Pratibha Singhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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