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Hudson A, Bobo D, Rueda Prada L, Dumic I, Petcu E, Cardozo M, Shweta F. Mania: An atypical presentation of probable Streptococcus agalactiae meningoencephalitis. IDCases 2023; 33:e01817. [PMID: 37645541 PMCID: PMC10461114 DOI: 10.1016/j.idcr.2023.e01817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 08/31/2023] Open
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a common pathogen in the neonatal period, causing meningitis and sepsis. In non-pregnant adults it is an unusual cause of meningitis. We report about an elderly female with several risk factors for invasive GBS infection who developed GBS meningoencephalitis one month after treatment for COVID-19 upper respiratory tract infection. The patient presented with mania, and the classic triad of headache, neck stiffness, and fever was absent which contributed to the delay in diagnosis. Following initiation of treatment with intravenous ceftriaxone she attained full recovery, and her behavior returned to baseline. This case illustrates an unusual presentation of an emerging infection and should alert clinicians about this presentation. By reporting this case we want to raise awareness about mania as a presenting feature of meningoencephalitis. This should lead to more timely diagnosis and better outcomes for future patients.
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Affiliation(s)
- Ann Hudson
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Daniel Bobo
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Emilia Petcu
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Milena Cardozo
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Fnu Shweta
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
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2
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Chen Z. Astragaloside iv inhibits salmonella-induced meningitis via modulation of bacterial virulence and host response. Pharmacogn Mag 2021. [DOI: 10.4103/pm.pm_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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Wald M, Merisor S, Zachary P, Augereau O, Gravier S, Jaulhac B, De Briel D, Velay A, Gregorowicz G, Martinot M. Microbiological Outcomes Associated With Low Leukocyte Counts in Cerebrospinal Fluid. Open Forum Infect Dis 2020; 8:ofaa597. [PMID: 33575417 PMCID: PMC7863864 DOI: 10.1093/ofid/ofaa597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022] Open
Abstract
The significance of low leukocyte counts in cerebrospinal fluid (CSF) remains unclear. We performed a 2-year retrospective study to examine microbiological outcomes associated with CSF leukocytes at 6–10/mm3. Of the 178 samples examined, we detected positive results for 11 samples, including 5 cases of tick-borne encephalitis virus infection.
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Affiliation(s)
- Mathieu Wald
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Simona Merisor
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Pierre Zachary
- Microbiology Department, Hôpitaux Universitaires de Strasbourg, France
| | | | - Simon Gravier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Benoit Jaulhac
- Microbiology Department, Hôpitaux Universitaires de Strasbourg, France
| | | | - Aurélie Velay
- Virology Department, Hôpitaux Universitaires de Strasbourg
| | | | - Martin Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
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Vestergaard HH, Larsen L, Brandt C, Hansen BR, Andersen CØ, Lüttichau HR, Helweg-Larsen J, Wiese L, Storgaard M, Nielsen H, Bodilsen J. Normocellular Community-Acquired Bacterial Meningitis in Adults: A Nationwide Population-Based Case Series. Ann Emerg Med 2020; 77:11-18. [PMID: 32747082 DOI: 10.1016/j.annemergmed.2020.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE This study sought to describe the clinical presentation of normocellular community-acquired bacterial meningitis in adults. METHODS Using the prospective, nationwide, population-based database of the Danish Study Group of Infections of the Brain, the study identified all adults with normocellular community-acquired bacterial meningitis who were treated at departments of infectious diseases in Denmark from 2015 through 2018. Normocellular community-acquired bacterial meningitis was defined as a cerebrospinal fluid leukocyte count of up to 10×106/L combined with detection of bacteria in the cerebrospinal fluid. Outcome was categorized according to the Glasgow Outcome Scale at discharge. RESULTS Normocellular cerebrospinal fluid was observed in 12 of 696 (2%) patients with community-acquired bacterial meningitis. The median age was 70 years (range 17 to 92 years), and 8 of 12 (67%) patients were male. All patients had symptoms suggestive of community-acquired bacterial meningitis and pathogens identified by culture (Streptococcus pneumoniae, n=10; Staphylococcus aureus, n=1) or polymerase chain reaction (Neisseria meningitidis; n=1) of the cerebrospinal fluid. Bacteremia was found in 9 of 12 (75%) patients, and 1 of 12 (8%) presented with septic shock. None of the patients had serious underlying immunocompromising conditions. The median times from admission to lumbar puncture and meningitis treatment were 2.5 hours (interquartile range 1.1 to 3.9 hours) and 2.6 hours (interquartile range 0.9 to 22.8 hours). In 3 of 11 (27%) patients, empiric treatment for community-acquired bacterial meningitis was interrupted by a normal cerebrospinal fluid cell count. The overall case-fatality rate was 3 of 12 (25%); meningitis treatment was interrupted in 1 of these patients, and 8 of 12 (67%) had a Glasgow Outcome Scale score of 1 to 4 at discharge. CONCLUSION Normocellular community-acquired bacterial meningitis is not very common, but it is important to consider and may be associated with a pneumococcal cause.
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Affiliation(s)
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Christian Brandt
- Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Birgitte R Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Christian Ø Andersen
- Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
| | - Hans R Lüttichau
- Department of Infectious Diseases, Herlev Gentofte Hospital, Copenhagen, Denmark
| | | | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
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Iguchi M, Noguchi Y, Yamamoto S, Tanaka Y, Tsujimoto H. Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. Cochrane Database Syst Rev 2020; 6:CD012824. [PMID: 32524581 PMCID: PMC7386453 DOI: 10.1002/14651858.cd012824.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Meningitis is inflammation of the meninges, the layers that protect the brain and spinal cord. Acute meningitis is an emergent disease that develops over the course of hours to several days. Delay in treatment can lead to serious outcomes. Inflammation of the meninges is assessed by analysing cerebrospinal fluid. Identifying the pathogen in cerebrospinal fluid is another way to diagnose meningitis. Cerebrospinal fluid is collected by doing a lumbar puncture, which is an invasive test, and can be avoided if a physical examination excludes the diagnosis of meningitis. However, most physical examinations, such as nuchal rigidity, Kernig's test, and Brudzinski's test, are not sufficiently sensitive to exclude meningitis completely. Jolt accentuation of headache is a new and less well-recognised physical examination, which assesses meningeal irritation. It is judged as positive if the headache is exacerbated by rotating the head horizontally two or three times per second. A 1991 observational study initially reported high sensitivity of this examination to predict pleocytosis. Pleocytosis, an abnormally high cerebrospinal fluid sample white cell count, is an accepted indicator of nervous system infection or inflammation. Jolt accentuation of headache may therefore accurately rule out meningitis without the use of lumbar puncture. However, more recent cross-sectional studies have reported variable diagnostic accuracy. OBJECTIVES To estimate the diagnostic accuracy of jolt accentuation of headache for detecting acute meningitis in emergency settings. Secondary objectives: to investigate the sources of heterogeneity, including study population, patient condition, and types of meningitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), and Embase (Elsevier) to 27 April 2020. We searched ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and Ichushi-Web Version 5.0 to 28 April 2020. SELECTION CRITERIA We included cross-sectional studies that assessed the diagnostic accuracy of jolt accentuation of headache for people with suspected meningitis in emergency settings. We included participants of any age and any severity of illness. Meningitis should be diagnosed with any reference standard, such as cerebrospinal fluid pleocytosis, proof of causative agents, or autopsy. DATA COLLECTION AND ANALYSIS Two review authors independently collated study data. We assessed methodological quality of studies using QUADAS-2 criteria. We used a bivariate random-effects model to determine summary estimates of sensitivity and specificity where meta-analysis was possible. We performed sensitivity analyses to validate the robustness of outcomes. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included nine studies (1161 participants). Five studies included only adults. Four studies included both adults and children; however, the proportion was not reported in three of these studies. The youngest child reported in the studies was aged 13 years. There was no study including only children. The reference standard was pleocytosis in eight studies, and the combination of pleocytosis and increased protein in the cerebrospinal fluid in one study. Two studies also used smear or positive culture of cerebrospinal fluid. Risk of bias and concern about applicability was high in the participant selection domain for all included studies and the consciousness subgroup. Overall, pooled sensitivity was 65.3% (95% confidence interval (CI) 37.3 to 85.6), and pooled specificity was 70.4% (95% CI 47.7 to 86.1) (very low-certainty evidence). We established the possibility of heterogeneity from visual inspection of forest plots. However, we were unable to conduct further analysis for study population, types of meningitis, and participants' condition, other than disturbance of consciousness (a secondary outcome). Amongst participants whose consciousness was undisturbed (8 studies, 921 participants), pooled sensitivity and specificity were 75.2% (95% CI 54.3 to 88.6) and 60.8% (95% CI 43.4 to 75.9), respectively (very low-certainty evidence). AUTHORS' CONCLUSIONS Jolt accentuation for headache may exclude diagnoses of meningitis in emergency settings, but high-quality evidence to support use of this test is lacking. Even where jolt accentuation of headache is negative, there is still the possibility of acute meningitis. This review identified the possibility of heterogeneity. However, factors that contribute to heterogeneity are incompletely understood, and should be considered in future research.
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Affiliation(s)
- Masahiro Iguchi
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Yoshinori Noguchi
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Nagoya-shi, Japan
| | - Shungo Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto-shi, Japan
| | - Yuu Tanaka
- Central Operation Room, Nara Medical University, Kasahara-shi, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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Jentzsch M, Schwind S, Vucinic V, Wendt S, Stingu CS, Niederwieser D, Weidhase L. Meningokokkensepsis ohne Liquorpathologie unter Eculizumabtherapie. Med Klin Intensivmed Notfmed 2020; 115:340-342. [DOI: 10.1007/s00063-019-0552-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/24/2022]
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Nabower AM, Miller S, Biewen B, Lyden E, Goodrich N, Miller A, Gollehon N, Skar G, Snowden J. Association of the FilmArray Meningitis/Encephalitis Panel With Clinical Management. Hosp Pediatr 2019; 9:763-769. [PMID: 31511395 DOI: 10.1542/hpeds.2019-0064] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine the association of the use of the multiplex assay meningitis/encephalitis panel with clinical management of suspected meningitis. METHODS A cross-sectional study was conducted with children 0 to 18 years of age who received a lumbar puncture within 48 hours of admission for an infectious workup. Patient demographic and presenting information, laboratory studies, and medication administration were collected. The primary measure was length of stay (LOS) with secondary measures: time on antibiotics, time to narrowing antibiotics, and acyclovir doses. LOS and antibiotic times were stratified for outcomes occurring before 36 hours. Logistic regression analysis was used to account for potential confounding factors associated with both the primary and secondary outcomes. A value of P < .05 was considered statistically significant. RESULTS Meningitis panel use was associated with a higher likelihood of a patient LOS <36 hours (P = .04; odds ratio = 1.7; 95% confidence interval [CI]: 1.03-2.87), a time to narrowing antibiotics <36 hours (P = .008; odds ratio = 1.89; 95% CI: 1.18-2.87), and doses of acyclovir (P < .001; incidence rate ratio = 0.37; 95% CI: 0.26-0.53). When controlling for potential confounding factors, these associations persisted. CONCLUSIONS Use of the meningitis panel was associated with a decreased LOS, time to narrowing of antibiotics, and fewer acyclovir doses. This likely is a result of the rapid turnaround time as compared with cerebrospinal fluid cultures. Additional studies to examine the outcomes related to this change in management are warranted.
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MESH Headings
- Acyclovir/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Cross-Sectional Studies
- Encephalitis, Herpes Simplex/cerebrospinal fluid
- Encephalitis, Herpes Simplex/diagnosis
- Encephalitis, Herpes Simplex/drug therapy
- Enterovirus Infections/cerebrospinal fluid
- Enterovirus Infections/diagnosis
- Enterovirus Infections/drug therapy
- Female
- Humans
- Infant
- Infant, Newborn
- Length of Stay/statistics & numerical data
- Male
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/diagnosis
- Meningitis, Bacterial/drug therapy
- Meningitis, Pneumococcal/cerebrospinal fluid
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/drug therapy
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/diagnosis
- Meningitis, Viral/drug therapy
- Real-Time Polymerase Chain Reaction
- Retrospective Studies
- Roseolovirus Infections/cerebrospinal fluid
- Roseolovirus Infections/diagnosis
- Roseolovirus Infections/drug therapy
- Spinal Puncture
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Affiliation(s)
| | - Sydney Miller
- College of Education and Health Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Benjamin Biewen
- College of Medicine, Creighton University, Omaha, Nebraska; and
| | - Elizabeth Lyden
- College of Public Health, Medical Center, University of Nebraska, Omaha, Nebraska
| | | | | | | | | | - Jessica Snowden
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Troendle M, Pettigrew A. A systematic review of cases of meningitis in the absence of cerebrospinal fluid pleocytosis on lumbar puncture. BMC Infect Dis 2019; 19:692. [PMID: 31382892 PMCID: PMC6683453 DOI: 10.1186/s12879-019-4204-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject. Methods Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. Results A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. In addition to bacteremia, concomitant sources of infection occurred in 17 cases. Conclusions Meningitis in the absence of pleocytosis on CSF is rare. If this occurs, causative organism is likely bacterial. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture. Electronic supplementary material The online version of this article (10.1186/s12879-019-4204-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Troendle
- Division of Clinical Toxicology, Attending Physician, Virginia Commonwealth University, 1250 East Marshall St., P.O. Box 980401, Richmond, VA, 23298-0401, USA.
| | - Alexis Pettigrew
- AAPettigrew, LLC, 2345 Rock Branch Ln, North Garden, VA, 22959, USA
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Young N, Thomas M. Meningitis in adults: diagnosis and management. Intern Med J 2019; 48:1294-1307. [PMID: 30387309 DOI: 10.1111/imj.14102] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/05/2018] [Accepted: 08/05/2018] [Indexed: 12/31/2022]
Abstract
Bacterial meningitis is a medical emergency. All clinicians who provide acute medical care require a sound understanding of the priorities of managing a patient with suspected meningitis during the first hour. These include obtaining blood cultures, performing lumbar puncture and initiating appropriate therapy, while avoiding harmful delays such as those that result from not administering treatment until neuroimaging has been performed. Despite the increasing availability of newer diagnostic techniques, the interpretation of cerebrospinal fluid parameters remains a vital skill for clinicians. International and local guidelines differ with regard to initial empirical therapy of bacterial meningitis in adults; the North American guideline recommends ceftriaxone and vancomycin for all patients, while the Australian, UK and European guidelines recommend that vancomycin only be added for patients who are more likely to have pneumococcal meningitis or who have a higher likelihood of being infected with a strain of Streptococcus pneumoniae with reduced susceptibility to ceftriaxone. Patients with risk factors for Listeria meningitis also require an anti-Listeria agent, such as benzylpenicillin, to be added to this treatment regimen. Dexamethasone should be a routine component of empirical therapy due to its proven role in reducing morbidity and mortality from pneumococcal meningitis.
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Affiliation(s)
- Nicholas Young
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand
| | - Mark Thomas
- Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
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Hage-Sleiman M, Derre N, Verdet C, Pialoux G, Gaudin O, Senet P, Fartoukh M, Boissan M, Garnier M. Meningococcal purpura fulminans and severe myocarditis with clinical meningitis but no meningeal inflammation: a case report. BMC Infect Dis 2019; 19:252. [PMID: 30871501 PMCID: PMC6419487 DOI: 10.1186/s12879-019-3866-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/01/2019] [Indexed: 01/04/2023] Open
Abstract
Background During fulminant meningococcal septicaemia, meningococci are often observed in the cerebrospinal fluid (CSF) although the patients have frequently no meningeal symptoms. Meningococcal meningitis, by contrast, usually features clinical meningeal signs and biochemical markers of inflammation with elevated white blood cell count (pleiocytosis) in the CSF. Cases of typical symptomatic meningitis without these biochemical features are uncommon in adults. Case presentation A 21-year-old male presented with meningococcal purpura fulminans and disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome requiring hospitalization in the Intensive Care Unit. Despite typical meningeal clinical signs, lumbar puncture showed no pleiocytosis, normal glycorachia and normal proteinorachia, whereas the lactate concentration in the CSF was high (5.8 mmol/L). CSF culture showed a high inoculum of serogroup C meningococci. On day 2, after initial improvement, a recurrence of hypotension led to the diagnosis of acute meningococcal myocarditis, which evolved favourably within a week. During the hospitalization, distal ischemic and necrotic lesions were observed, predominantly on the fingertips, which were treated with local and systemic vasodilators. Conclusions We report a rare case of adult meningococcal disease characterized by an intermediate form of meningitis between purulent meningitis and meningeal inoculation from fulminant meningococcal septicaemia, without classical signs of biological inflammation. It highlights the diagnostic value of CSF lactate, which may warrant administration of a meningeal dosing regimen of beta-lactam antibiotics. This case also demonstrates the potential severity of meningococcal myocarditis; we discuss its pathophysiology, which is distinct from other sepsis-related cardiomyopathies. Finally, the observed effects of vasodilators on the meningococcal skin ischemia in this case encourages future studies to assess their efficacy in DIC-associated necrosis.
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Affiliation(s)
- Mehdi Hage-Sleiman
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Biochemistry Laboratory, 4 Rue de la Chine, 75020, Paris, France
| | - Nicolas Derre
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Medico-Surgical Intensive Care Unit, 4 Rue de la Chine, Paris, 75020, France
| | - Charlotte Verdet
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalo-Universitaire Paris Est, Bacteriology Laboratory, 184 Rue du Faubourg Saint-Antoine, Paris, 75012, France
| | - Gilles Pialoux
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Infectious Diseases Department, 4 Rue de la Chine, Paris, 75020, France
| | - Olivier Gaudin
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Anatomopathology Laboratory, 4 Rue de la Chine, Paris, 75020, France
| | - Patricia Senet
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Dermatology Department, 4 Rue de la Chine, Paris, 75020, France
| | - Muriel Fartoukh
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Medico-Surgical Intensive Care Unit, 4 Rue de la Chine, Paris, 75020, France.,Sorbonne University School of Medicine, Paris VI, Paris, France
| | - Mathieu Boissan
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Biochemistry Laboratory, 4 Rue de la Chine, 75020, Paris, France.,Sorbonne University School of Medicine, Paris VI, Paris, France.,INSERM UMR-S 938, Saint-Antoine Research Center, Sorbonne Université, Paris, France
| | - Marc Garnier
- Assistance Publique-Hôpitaux de Paris (APHP), Tenon University Hospital, Medico-Surgical Intensive Care Unit, 4 Rue de la Chine, Paris, 75020, France. .,Sorbonne University School of Medicine, Paris VI, Paris, France. .,Assistance Publiuqe-Hôpitaux de Paris (APHP), Tenon University Hospital, Anaesthesiology and Intensive Care Medicine Department, 4 Rue de la Chine -, 75020, Paris, France.
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Tamune H, Kuki T, Kashiyama T, Uchihara T. Does This Adult Patient With Jolt Accentuation of Headache Have Acute Meningitis? Headache 2018; 58:1503-1510. [PMID: 30178879 DOI: 10.1111/head.13376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In order to identify appropriate candidates with suspected meningitis for lumbar puncture (LP), study designs and diagnostic values of jolt accentuation of headache (JA) were reviewed. BACKGROUND Acute meningitis is a life-threatening disease that requires LP for accurate diagnosis. JA was reported the most sensitive indicator of cerebrospinal fluid pleocytosis; however, subsequent studies have failed to confirm this claim. METHODS We reviewed articles concerning JA, published prior to December 2017, using MEDLINE and Japanese medical databases. Seven original articles based on independent cohorts were eligible for inclusion and articles citing these 7 were thoroughly searched (11 in total). Additionally, all medical records of our previously reported cohort were reviewed again to explore how the patients' background influenced diagnostic values of JA. RESULTS We hypothesized that an oversimplified dichotomy of JA findings, pleocytosis, and meningitis created a misconception that JA is a universal indicator of meningitis. We clarify the difference between them and present altered mental status (AMS) as a key to decrease the sensitivity of JA. Notably, the sensitivity and specificity of JA were relatively low in unselected groups, while they tended to be high in the selected sub-groups with acute onset of headache and fever, without AMS or neurological deficits. Unselected populations included etiologies of pleocytosis other than acute meningitis, which might weaken the association between JA and pleocytosis. CONCLUSION JA is not a universal, stand-alone, indicator of meningitis in febrile patients with headache. Therefore, we propose a stepwise approach for patients with suspected acute meningitis. AMS or neurological deficits suggest an intracranial pathology, which may necessitate a lumbar puncture. JA seems a useful tool for distinguishing acute aseptic meningitis from upper respiratory infection when used in the selected cohort of febrile patients (≥37°C) with recent-onset headache (within 2 weeks before presentation) and normal mental status. This approach and diagnostic values of JA should be further investigated by prospective studies using operationally sorted candidates.
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Affiliation(s)
- Hidetaka Tamune
- Department of Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Neuropsychiatry, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaie Kuki
- Department of Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Internal Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuya Kashiyama
- Department of Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Toshiki Uchihara
- Department of Neurology, Nitobe-Memorial Nakano General Hospital, Tokyo, Japan
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Mado S, Aliyu I, Murtala R. Changing Pattern of Childhood Epidemic Cerebrospinal Meningitis in North-Western Nigeria. J Neurosci Rural Pract 2018; 9:203-207. [PMID: 29725170 PMCID: PMC5912025 DOI: 10.4103/jnrp.jnrp_384_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Nigeria lies within the meningitis belt which extends from the Gambia, Senegal through Nigeria to Eritrea; however, outbreaks have been shown to extend further south involving countries such as Angola and Namibia. Epidemic outbreaks are often recorded every 8-12 years averaging in a 10 yearly circle however endemic cases still occurs. Materials and Methods The study was retrospective; all results of cerebrospinal fluid (CSF) samples of children with cases of meningitis from January 2010 to December 2010 were collected from the register of the microbiology laboratory of General Hospital Gusau. Relevant information such as their age, sex, CSF macroscopy/microscopy reports, latex particle agglutination test report, and CSF culture report were retrieved and entered into a pro forma. Results There were 89 (73%) males and 33 (27%) females with male to female ratio of 2.7:1. The age ranged from 2 months to 14 years; the mean was 6.27 ± 4.00 years. Meningitis was mostly recorded from January to April. W135 was the most common serotype identified. Majority of the samples (54) which were nonreactive for any of the tested antigens had clear CSF (36), while among those that reacted; the W135 group had a high proportion of cases that had turbid CSF (44); (Fisher's exact test = 30.650, P = 0.000). Majority of the samples (99) had no cell count; although those of the W135 group had higher cell counts followed by those in the nonreactive group (Fisher's exact test = 11.226, P = 0.181). Conclusion Meningitis was highest between January and April, and W135 was the most common serotype.
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Affiliation(s)
- Sani Mado
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Ibrahim Aliyu
- Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Rabiu Murtala
- Department of Laboratory, Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria
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Abstract
Acute meningitis remains a devastating disease. Clinicians need a low threshold for suspecting meningitis, to undertake appropriate investigations and provide treatment in a timely manner, to minimise the risk of poor outcome in bacterial disease, while limiting unnecessary treatment in viral meningitis.
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Affiliation(s)
- Michael J Griffiths
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- National Institute of Health Research Health Research Protection Unit in Emerging and Zoonotic infections, UK
| | - Fiona McGill
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- SpR in microbiology and infectious diseases, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- National Institute of Health Research Health Research Protection Unit in Emerging and Zoonotic infections, UK
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- National Institute of Health Research Health Research Protection Unit in Emerging and Zoonotic infections, UK
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15
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Mehmood H, Khan N, Ullah S, Ullah A, Marwat A. A Rare Case of Sphingomonas paucimobilis Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis. J Investig Med High Impact Case Rep 2018; 6:2324709618756424. [PMID: 29435467 PMCID: PMC5802606 DOI: 10.1177/2324709618756424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 12/01/2022] Open
Abstract
Sphingomonas paucimobilis is a nonfermentative gram-negative bacillus of low pathogenicity. The organism has been involved in causing a wide range of infections in community and hospital settings. Only 3 cases of meningitis caused by this organism have been reported so far. We report a rare case of S paucimobilis meningitis who presented with atypical symptoms. A 50-year-old female presented with headache, dizziness, chills, shakiness, and neck pain along with nuchal rigidity. On physical examination, severe neck rigidity along with decreased range of motion was noticed. Her cerebrospinal fluid showed gram-negative rods, and she was started on meropenem. The cerebrospinal fluid grew S paucimobilis sensitive to meropenem. She subsequently showed significant improvement and was discharged home on intravenous meropenem for 21 days and showed complete recovering in 5 weeks.
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Affiliation(s)
- Hassan Mehmood
- Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Noman Khan
- Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Saad Ullah
- Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Asad Ullah
- Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Asghar Marwat
- Temple University/Conemaugh Memorial Medical Center, Johnstown, PA, USA
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16
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Iguchi M, Noguchi Y, Yamamoto S, Tanaka Y, Tsujimoto H. Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. Hippokratia 2017. [DOI: 10.1002/14651858.cd012824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Masahiro Iguchi
- Fukushima Medical University; Department of Neurology; 1 Hikarigaoka Fukushima Fukushima Japan 960-1295
| | - Yoshinori Noguchi
- Japanese Red Cross Nagoya Daini Hospital; Department of General Internal Medicine; Myoken-cho 2-9 Showa-ku Nagoya-shi Aichi Japan 466-8650
| | - Shungo Yamamoto
- School of Public Health; Department of Healthcare Epidemiology; Graduate School of Medicine, Kyoto University Yoshida Konoemachi, Sakyo-ku Kyoto-shi Kyoto Japan 606-8501
| | - Yuu Tanaka
- Nara Medical University; Central Operation Room; Shijo-cho 840 Kasahara-shi Nara Japan 634-8522
| | - Hiraku Tsujimoto
- Hyogo Prefectural Amagasaki General Medical Center; Hospital Care Research Unit; Higashi-Naniwa-Cho 2-17-77 Amagasaki Hyogo Japan 606-8550
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17
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Macken M, Wacogne ID. Do antibiotics affect cerebrospinal fluid results? Arch Dis Child 2017; 102:990-993. [PMID: 28847878 DOI: 10.1136/archdischild-2017-313610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Marita Macken
- General Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - Ian D Wacogne
- General Paediatrics, Birmingham Children's Hospital, Birmingham, UK
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18
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Abstract
Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections.
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Affiliation(s)
- Felix Benninger
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
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19
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Troendle M, Willis D. Fulminant bacterial meningitis due to Neisseria meningitidis with no pleocytosis on lumbar puncture. Am J Emerg Med 2017; 35:198.e1-198.e2. [DOI: 10.1016/j.ajem.2016.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/16/2016] [Indexed: 12/29/2022] Open
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20
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Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults. J Clin Microbiol 2016; 54:1851-1854. [PMID: 27170017 DOI: 10.1128/jcm.00149-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/03/2016] [Indexed: 11/20/2022] Open
Abstract
Microbiological tests on cerebrospinal fluid (CSF) utilize a common urgent-care procedure that does not take into account the chemical and cytological characteristics of the CSF, resulting sometimes in an unnecessary use of human and diagnostic resources. The aim of this study was to retrospectively validate a simple scoring system (bacterial meningitis-Careggi score [BM-CASCO]) based on blood and CSF sample chemical/cytological parameters for evaluating the probability of acute bacterial meningitis (ABM) in adults. BM-CASCO (range, 0 to 6) was defined by the following parameters: CSF cell count, CSF protein levels, CSF lactate levels, CSF glucose-to-serum glucose ratio, and peripheral neutrophil count. BM-CASCO was retrospectively calculated for 784 cases of suspected ABM in adult subjects observed during a four-and-a-half-year-period (2010 to 2014) at the emergency department (ED) of a large tertiary-care teaching hospital in Italy. Among the 28 confirmed ABM cases (3.5%), Streptococcus pneumoniae was the most frequent cause (16 cases). All ABM cases showed a BM-CASCO value of ≥3. Most negative cases (591/756) exhibited a BM-CASCO value of ≤1, which was adopted in our laboratory as a cutoff to not proceed with urgent microbiological analysis of CSF in cases of suspected ABM in adults. During a subsequent 1-year follow-up, the introduction of the BM-CASCO in the diagnostic workflow of ABM in adults resulted in a significant decrease in unnecessary microbiological analysis, with no false negatives. In conclusion, BM-CASCO appears to be an accurate and simple scoring system for optimization of the microbiological diagnostic workflow of ABM in adults.
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Costerus J, Brouwer M, van der Ende A, van de Beek D. Repeat lumbar puncture in adults with bacterial meningitis. Clin Microbiol Infect 2016; 22:428-33. [DOI: 10.1016/j.cmi.2015.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 01/30/2023]
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22
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Ye Q, Shao WX, Shang SQ, Shen HQ, Chen XJ, Tang YM, Yu YL, Mao JH. Clinical Value of Assessing Cytokine Levels for the Differential Diagnosis of Bacterial Meningitis in a Pediatric Population. Medicine (Baltimore) 2016; 95:e3222. [PMID: 27043692 PMCID: PMC4998553 DOI: 10.1097/md.0000000000003222] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022] Open
Abstract
We performed a prospective observational study to evaluate the utility of measuring inflammatory cytokine levels to discriminate bacterial meningitis from similar common pediatric diseases. Inflammatory cytokine levels and other cerebrospinal fluid (CSF) physicochemical indicators were evaluated in 140 patients who were diagnosed with bacterial meningitis via microbiological culture or PCR assay. The CSF concentrations of interleukin (IL)-6 and IL-10, CSF/blood IL-6 and IL-10 ratios, CSF white blood cell count, and CSF micro total protein were significantly elevated in bacterial meningitis patients compared with healthy children or patients with viral encephalitis, epilepsy, or febrile convulsions (P < 0.001). The area under the curve values for CSF concentrations of IL-6 and IL-10, CSF/blood IL-6 and IL-10 ratios, CSF white blood cell count, and CSF micro total protein to identify bacterial meningitis episodes by receiver-operating characteristic analysis were 0.988, 0.949, 0.995, 0.924, 0.945, and 0.928, respectively. The area under the curve for the combination of CSF IL-6 and CSF/blood IL-6 ratio was larger than that for either parameter alone, and the combination exhibited enhanced specificity and positive predictive value. After effective meningitis treatment, CSF IL-6 levels dropped significantly. These results suggest that CSF IL-6 and CSF/blood IL-6 ratio are good biomarkers in discriminating bacterial meningitis. Evaluating CSF IL-6 and CSF/blood IL-6 ratio in combination can improve diagnostic efficiency. Additionally, CSF IL-6 levels can be used to monitor the effects of bacterial meningitis treatment.
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Affiliation(s)
- Qing Ye
- From the Zhejiang Key Laboratory for Neonatal Diseases (QY, S-QS, H-QS, X-JC, Y-MT, Y-LY, J-HM), The Children's Hospital of Zhejiang University School of Medicine; and Clinical Laboratory (W-XS), Hangzhou First People's Hospital, Hangzhou, China
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23
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Jolobe OM. The wider implications of normal cerebrospinal fluid cellularity in pneumococcal meningitis. Am J Emerg Med 2016; 34:657. [DOI: 10.1016/j.ajem.2015.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022] Open
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24
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Chacon-Cruz E, Martinez-Longoria CA, Llausas-Magana E, Luevanos-Velazquez A, Vazquez-Narvaez JA, Beltran S, Limon-Rojas AE, Urtiz-Jeronimo F, Castaneda-Narvaez JL, Otero-Mendoza F, Aguilar-Del Real F, Rodriguez-Chagoyan J, Rivas-Landeros RM, Volker-Soberanes ML, Hinojosa-Robles RM, Arzate-Barbosa P, Aviles-Benitez LK, Elenes-Zamora FI, Becka CM, Ruttimann R. Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance. THERAPEUTIC ADVANCES IN VACCINES 2016; 4:15-9. [PMID: 27551428 DOI: 10.1177/2051013616650158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals. METHODS From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods. RESULTS Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants). CONCLUSIONS Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures - negative but presumably bacterial meningitis cases.
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Affiliation(s)
- Enrique Chacon-Cruz
- Hospital General de Tijuana, Paseo Centario S/N, Zona del Rio, Tijuana, 22010, Mexico
| | | | - Eduardo Llausas-Magana
- Hospital Pediatrico de Sinaloa 'Dr. Rigoberto Aguilar Pico,' Culiacan, Sinaloa, Culiacan, Mexico
| | | | | | - Sandra Beltran
- Hospital General 'Dr. Rafael Pascacio Gamboa,' Tuxtla Gutierrez Chiapas, Tuxtla Gutierrez, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | - Chandra M Becka
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, New Orleans, LA, USA
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25
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Govea-Camacho LH, Pérez-Ramírez R, Cornejo-Suárez A, Fierro-Rizo R, Jiménez-Sala CJ, Rosales-Orozco CS. [Diagnosis and treatment of the complications of otitis media in adults. Case series and literature review]. CIR CIR 2015; 84:398-404. [PMID: 26738650 DOI: 10.1016/j.circir.2015.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The complications of otitis media (intra-cranial and extra-cranial) used to have a high morbidity and mortality in the pre-antibiotic era, but these are now relatively rare, mainly due to the use of antibiotics and the use of ventilation tubes, reducing the incidence of such complications significantly. Currently, an early suspicion of these complications is a major challenge for diagnosis and management. CLINICAL CASES The cases of 5 patients (all male) are presented, who were diagnosed with complicated otitis media, 80% (4) with a mean age of 34.6 years (17-52). There was major comorbidity in 60% (3), with one patient with diabetes mellitus type 2, and two with chronic renal failure. There were 3 (60%) intra-cranial complications: one patient with thrombosis of the sigmoid sinus and a cerebellar abscess; another with a retroauricular and brain abscess, and a third with meningitis. Of the 2 (40%) extra-cranial complications: one patient had a Bezold abscess, and the other with a soft tissue abscess and petrositis. All patients were managed with surgery and antibiotic therapy, with 100% survival (5), and with no neurological sequelae. The clinical course of otitis media is usually short, limiting the infection process in the majority of patients due to the immune response and sensitivity of the microbe to the antibiotic used. However, a small number of patients (1-5%) may develop complications. CONCLUSION Otitis media is a common disease in our country, complications are rare, but should be suspected when the picture is of torpid evolution with clinical worsening and manifestation of neurological signs.
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Affiliation(s)
- Luis Humberto Govea-Camacho
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México
| | - Ramón Pérez-Ramírez
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México.
| | - Arnulfo Cornejo-Suárez
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México
| | - Roberto Fierro-Rizo
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México
| | - Claudia Janet Jiménez-Sala
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México
| | - Carlos Silvino Rosales-Orozco
- Otorrinolaringología y Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Médico del Seguro Social (IMSS), Guadalajara, México
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