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Valtiala E, Roine I, Cruzeiro ML, Peltola H, Pelkonen T. Seizures, focal neurological signs, and pneumococcal aetiology associate with impaired consciousness in childhood bacterial meningitis. Acta Paediatr 2024; 113:1644-1652. [PMID: 38511552 DOI: 10.1111/apa.17217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/09/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
AIM A low Glasgow Coma Scale Score (GCS) on admission is a known predictor of poor outcome from childhood bacterial meningitis. In turn, the factors associated with the admission GCS are less known. Our aim was to identify them, both for clinical alerts of reserved prognosis and to find potential targets for intervention. METHODS This study is a secondary analysis of data collected prospectively in Angola and in Latin America between 1996 and 2007. Children with bacterial meningitis were examined on hospital admission and their GCS was assessed using the age-adjusted scale. Associations between on-admission GCS and host clinical factors were examined. RESULTS A total of 1376 patients with confirmed bacterial meningitis were included in the analysis (609 from Latin America and 767 from Angola). The median GCS was 13 for all patients (12 in Angola and 13 in Latin America). In the multivariate analysis, in the areas combined, seizures, focal neurological signs, and pneumococcal aetiology associated with GCS <13, as did treatment delay in Latin America. CONCLUSION Besides pneumococcal aetiology, we identified characteristics, easily registrable on admission, which are associated with a low GCS in childhood bacterial meningitis. Of these, expanding pneumococcal vaccinations and treatment delays could be modified.
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Affiliation(s)
- Ester Valtiala
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Heikki Peltola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Pelkonen
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland
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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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Mbakwe PL, Roine I, Cruzeiro ML, Kallio M, Peltola H, Pelkonen T. Clinical Picture and Risk Factors for Poor Outcome in Streptococcus pneumoniae Meningitis of Childhood on Three Continents. Pediatr Infect Dis J 2024; 43:415-419. [PMID: 38359336 PMCID: PMC11003404 DOI: 10.1097/inf.0000000000004265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Streptococcus pneumoniae meningitis (SpM) remains a major health burden worldwide, particularly in low- and middle-income countries. Identifying the patients at highest risk for mortality and disabling sequelae may reveal potentially avoidable predisposing factors and identify patients most in need of intensive care. We searched for factors that do not require laboratory facilities. METHODS This study was a secondary analysis of prospectively collected data from 5 clinical trials of childhood bacterial meningitis on 3 continents between 1984 and 2017. SpM cases were analyzed by study site and predictors for poor outcome (death or severe sequelae) were identified from the whole series, Latin America and Angola. RESULTS Among a total of 1575 children (age range: 2 months to 15 years), 505 cases were due to pneumococci. Compared to other etiologies, SpM doubled the death rate (33% vs. 17%) and tripled poor outcome (15% vs. 6%). In SpM, Glasgow Coma Score <13 [odds ratio (OR): 4.73] and previous antibiotics in Angola (OR: 1.70) were independent predictors for death. Predictors for poor outcome were age <1 year (OR: 2.41) and Glasgow Coma Score <13 (OR: 6.39) in the whole series, seizures in Latin America (OR: 3.98) and previous antibiotics in Angola (OR: 1.91). Angolan children had a 17-fold increased risk for poor outcome when compared with Finnish children ( P = 0.011). CONCLUSIONS Our study proved the severity of SpM when compared with other etiologies. The outcome was especially poor in Angola. Most patients at risk for poor outcome are easily identified by clinical factors on admission.
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Affiliation(s)
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Markku Kallio
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki Peltola
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Pelkonen
- Serviço de Neuroinfecciologia, Hospital Pediátrico David Bernardino, Luanda, Angola
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children’s Hospital, Pediatric Research Center, Helsinki, Finland
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Adawe DH, Mengistie DT. Determine the factors affecting the time to recovery of children with bacterial meningitis at Jigjiga university referral hospital in the Somali Regional State of Ethiopia: using the parametric shared frailty and AFT models. BMC Res Notes 2024; 17:85. [PMID: 38504305 PMCID: PMC10953244 DOI: 10.1186/s13104-024-06740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Neisseria meningitides, Streptococcus pneumonia, and hemophilic influenza type B are frequently linked to bacterial meningitis (BM) in children. It's an infectious sickness that kills and severely mobilizes children. For a variety of reasons, bacterial meningitis remains a global public health concern; most cases and deaths are found in Sub-Saharan Africa, particularly in Ethiopia. Even though vaccination has made BM more preventable, children worldwide are still severely harmed by this serious illness. Age, sex, and co-morbidity are among the risk variables for BM that have been found. Therefore, the main objective of this study was to identify the variables influencing the time to recovery for children with bacterial meningitis at Jigjiga University referral hospital in the Somali regional state of Ethiopia. METHOD A retrospective cohort of 535 children with bacterial meningitis who received antibiotic treatment was the subject of this study. Parametric Shared Frailty ty and the AFT model were employed with log likelihood, BIC, and AIC methods of model selection. The frailty models all employed the patients' kebele as a clustering factor. RESULTS The number of cases of BM declined in young children during the duration of the 2 year, 11 month study period, but not in the elderly. Streptococcus pneumonia (50%), hemophilic influenza (30.5%), and Neisseria meningitides (15%) were the most frequent causes of BM. The time to recovery of patients from bacteria was significantly influenced by the covariates male patients (ϕ = 0.927; 95% CI (0.866, 0.984); p-value = 0.014), patients without a vaccination history (ϕ = 0.898; 95% CI (0.834, 0.965); P value = 0.0037), and patients who were not breastfeeding (ϕ = 0.616; 95% CI (0.404, 0.039); P-value = 0.024). The recovery times for male, non-breastfed children with bacterial patients are 7.9 and 48.4% shorter, respectively. In contrast to children with comorbidity, the recovery time for children without comorbidity increased by 8.7%. CONCLUSION Age group, sex, vaccination status, co-morbidity, breastfeeding, and medication regimen were the main determinant factors for the time to recovery of patients with bacterial meningitis. Patients with co-morbidities require the doctor at Jigjiga University Referral Hospital to pay close attention to them.
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Affiliation(s)
- Daud Hussein Adawe
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia.
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Bacha T, Obremskey A, Buxton J, Fink EL, von Saint Andre-von Arnim A, Raees M. Practice patterns in pediatric infectious encephalopathy in four centers in Africa. Front Pediatr 2024; 12:1304245. [PMID: 38464900 PMCID: PMC10920287 DOI: 10.3389/fped.2024.1304245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Infectious encephalopathy (IE), including meningitis, infectious encephalitis, and cerebral abscess, remains prevalent and carries high mortality and morbidity in children, especially in low and middle income countries (LMIC). This study aims to describe the usual care and outcomes of pediatric IE in four LMIC hospitals in sub-Saharan Africa to support evidence-based care guideline development. Methods This is a secondary analysis of the Prevalence of Acute Critical Neurological disease in children: A Global Epidemiological Assessment-Developing Countries study, a 4-week, prospective, observational study in children (1 week to 17 years) with IE presenting to referral hospitals in Ethiopia, Kenya, Rwanda, and Ghana. Data collection included diagnostic testing, interventions, and patient outcomes [e.g., mortality, Pediatric Cerebral and Overall Performance Category Scores (PCPC and POPC)]. Results Seventy-two children with IE were enrolled. Most patients were diagnosed with undifferentiated IE (78%, n = 56). Specific etiologies included cerebral malaria (10%, n = 7), viral encephalitis (4%, n = 3), tuberculosis (4%, n = 3), bacterial meningitis (3%, n = 2), and cerebral abscess (1%, n = 1). Fourteen patients (20%) had a head computed tomography performed. Thirty two (44%) children had a lumbar puncture but only 9 samples (28%) were sent for culture. Median time from diagnosis to antimicrobial therapy was 3 h (IQR 1-12 h). Half (51%, n = 33) of inpatients received intracranial pressure (ICP)-directed treatment but none underwent ICP monitoring. Mortality was 13% (n = 9). The percentage of children with a favorable cognitive score decreased from 95% (n = 62) prior to admission to 80% (n = 52) and 77% (n = 50) at discharge for PCPC and POPC respectively. Discussion IE led to considerable morbidity and mortality in this cohort, and evaluation and management varied across the care continuum. Resource limitations and diagnostic constraints may have affected diagnosis-directed therapy and other aspects of management. Further studies are needed to describe the epidemiology and management of IE in LMICs to inform future treatment protocols, the role of technological and human capacity building to support both basic monitoring and interventions, as well as creative new solutions to emergency and critical care in these settings.
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Affiliation(s)
- Tigist Bacha
- Department of Pediatrics and Child Health, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alexandra Obremskey
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jessica Buxton
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, United States
| | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children’s, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Madiha Raees
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Chekrouni N, Kroon M, Drost EHGM, van Soest TM, Bijlsma MW, Brouwer MC, van de Beek D. Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study. Ann Intensive Care 2023; 13:124. [PMID: 38055180 DOI: 10.1186/s13613-023-01218-6] [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: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. METHODS We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1-4) by multivariable logistic regression. RESULTS A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49-69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. CONCLUSIONS The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.
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Affiliation(s)
- Nora Chekrouni
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merel Kroon
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Evelien H G M Drost
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Thijs M van Soest
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merijn W Bijlsma
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
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7
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Pathan AF, Seth NH, Deodhe NP. Scope of an Integrative Neurophysiotherapy Approach in Achieving Gross Motor Milestones in a Child with Meningitis: A Case Report. Cureus 2023; 15:e49540. [PMID: 38156138 PMCID: PMC10753267 DOI: 10.7759/cureus.49540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/26/2023] [Indexed: 12/30/2023] Open
Abstract
Meningitis caused by bacteria, which is an inflammation of the meninges affecting the pia, arachnoid, and subarachnoid space, is still one of the leading causes of death and morbidity in infants and young children. Neisseria meningitidis, group B streptococcus (GBS), Haemophilus influenzae type B (Hib), Listeria monocytogenes, and Streptococcus pneumoniae have been found to be the most frequent causative agents. Infants and children can have modest, fluctuating, non-specific, or even absent clinical signs of bacterial meningitis. They may include bulging fontanelles, vomiting, diarrhea, respiratory distress, hypothermia, lethargy, irritability, poor feeding, and fever in babies. In this case report, an 18-month-old child presented to a local hospital with complaints of multiple episodes of high-grade fever. After 10 days, his symptoms worsened and he experienced two episodes of seizures at one-day intervals at night. He was taken to Acharya Vinoba Bhave Rural Hospital for further management. Blood investigations revealed seropositive results for dengue virus infection. On MRI and CT scan, it was diagnosed as an old case of subdural hematoma in the right frontotemporal region of the brain. The patient was on intravenous ceftriaxone and phenytoin. Gross motor developmental milestones in children with meningitis can be improved with early integrative neurophysiotherapy and a goal-oriented therapeutic regimen that includes mobility exercises, proprioceptive neuromuscular facilitation techniques, positioning, oromotor retraining, neurodevelopmental techniques, and balance and coordination retraining. A complex case presents with bacterial meningitis, hydrocephalus, and seizure disorder. The bacterial infection inflames the protective membranes of the brain, causing hydrocephalus. Increased cerebrospinal fluid puts pressure on the brain, leading to seizures. Managing these interconnected conditions requires a multidisciplinary approach making it unique, involving infectious disease, neurology, and neurosurgery expertise.
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Affiliation(s)
- Anam F Pathan
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishigandha P Deodhe
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhou Q, Zhan Z, Huang F, Zhao M, Huang D, Xu J, Huang L, Xie L, Zhang A. Case report: A rare multidrug-resistant Escherichia coli causes fatal neonatal meningoencephalitis. Front Public Health 2023; 11:1174536. [PMID: 37575122 PMCID: PMC10420072 DOI: 10.3389/fpubh.2023.1174536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023] Open
Abstract
Neonatal meningitis is rare but devastating disease. Multidrug-resistant (MDR, multi-drug resistant) bacteria are a major global health risk. We report an Escherichia coli meningitis isolate with multiple resistance patterns and unusual serotype (O75) that caused sudden neonatal death. The isolate was resistant to antibiotics other than cefoperazone/sulbactam and imipenem, challenging the combination of antibiotics commonly used in the empirical treatment of neonatal sepsis. Despite aggressive symptomatic and supportive treatment of the infant based on laboratory tests and clinical practice, the infant eventually died. This is the first case of meningoencephalitis due to serotype O75 reported in China. The presence of highly pathogenic multidrug-resistant microorganisms isolated in neonates underscores the need to implement rapid resistance diagnostic methods and should prompt consideration of alternatives to empiric treatment of neonatal bacterial meningitis.
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Affiliation(s)
- Qingyun Zhou
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Zhifei Zhan
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Furong Huang
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Menghua Zhao
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Daosheng Huang
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jun Xu
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Li Huang
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Liangyi Xie
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Aimin Zhang
- The First-Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, Hunan, China
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Wu J, Song X, Hu Y, Chen J, Jiang L. High-risk factors associated with refractory childhood bacterial meningitis in Southwest China. BMC Pediatr 2023; 23:220. [PMID: 37147568 PMCID: PMC10163699 DOI: 10.1186/s12887-023-04007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Refractory bacterial meningitis is acute, develops rapidly, and has higher mortality and morbidity than common bacterial meningitis. This study was undertaken to investigate the high-risk factors related to refractory bacterial meningitis in children with positive pathogens. METHODS We retrospectively analyzed the clinical data of 109 patients who had bacterial meningitis. The patients were divided into a refractory group (96 patients) and nonrefractory group (13 patients) based on the classification criteria. Seventeen clinical variables on risk factors were extracted and evaluated by univariate and multivariate logistic regression analyses. RESULTS There were 64 males and 45 females. The onset age ranged from 1 month old to 12 years old, and the median age was 181 days old. The pathogenic bacteria included 67 cases of gram-positive (G+) bacteria (61.5%) and 42 cases of gram-negative (G-) bacteria. In patients who were 1 to 3 months old, E. coli was the most common (47.5%), followed by Streptococcus agalactiae and Staphylococcus hemolyticus (10.0%); in patients > 3 months old, S. pneumoniae was the most common (55.1%), followed by E. coli (8.7%). The multivariate analysis indicated that consciousness disorder (odds ratio [OR] = 13.050), peripheral blood C-reactive protein (CRP) ≥ 50 mg/L (OR = 29.436), and the isolate bacteria being gram-positive bacteria (OR = 8.227) were independent risk factors for predicting who would progress to refractory bacterial meningitis in this group. CONCLUSION For patients who have pathogenic positive bacterial meningitis along with consciousness disorder, CRP ≥ 50 mg/L, and/or have an isolate bacteria that is a G + bacteria, it is important to be alert to the potential for progression to refractory bacterial meningitis, which demands the physicians' significant attention.
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Affiliation(s)
- JinFeng Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - XiaoJie Song
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Chong SL, Niu C, Piragasam R, Koh ZX, Guo D, Lee JH, Ong GYK, Ong MEH, Liu N. Adding heart rate n-variability (HRnV) to clinical assessment potentially improves prediction of serious bacterial infections in young febrile infants at the emergency department: a prospective observational study. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:6. [PMID: 36760240 PMCID: PMC9906196 DOI: 10.21037/atm-22-3303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
Background We aim to investigate the utility of heart rate variability (HRV) and heart rate n-variability (HRnV) in addition to vital signs and blood biomarkers, among febrile young infants at risk of serious bacterial infections (SBIs). Methods We performed a prospective observational study between December 2017 and November 2021 in a tertiary paediatric emergency department (ED). We included febrile infants <90 days old with a temperature ≥38 ℃. We obtained HRV and HRnV parameters via a single lead electrocardiogram. HRV measures beat-to-beat (R-R) oscillation and reflects autonomic nervous system (ANS) regulation. HRnV includes overlapping and non-overlapping R-R intervals and provides additional physiological information. We defined SBIs as meningitis, bacteraemia and urinary tract infections (UTIs). We performed area under curve (AUC) analysis to assess predictive performance. Results We recruited 330 and analysed 312 infants. The median age was 35.5 days (interquartile range 13.0-61.0); 74/312 infants (23.7%) had SBIs with the most common being UTIs (66/72, 91.7%); 2 infants had co-infections. No patients died and 32/312 (10.3%) received fluid resuscitation. Adding HRV and HRnV to demographics and vital signs at ED triage successively improved the AUC from 0.765 [95% confidence interval (CI): 0.705-0.825] to 0.776 (95% CI: 0.718-0.835) and 0.807 (95% CI: 0.752-0.861) respectively. The final model including demographics, vital signs, HRV, HRnV and blood biomarkers had an AUC of 0.874 (95% CI: 0.828-0.921). Conclusions Addition of HRV and HRnV to current assessment tools improved the prediction of SBIs among febrile infants at ED triage. We intend to validate our findings and translate them into tools for clinical care in the ED.
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Affiliation(s)
- Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Rupini Piragasam
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | - Zhi Xiong Koh
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Dagang Guo
- Duke-NUS Medical School, Singapore, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Gene Yong-Kwang Ong
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Liu
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Health Services Research Centre, Singapore Health Services, Singapore, Singapore
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11
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Risk Factors for Death and Severe Neurological Sequelae in Childhood Bacterial Meningitis. Pediatr Emerg Care 2022; 38:637-643. [PMID: 36190396 DOI: 10.1097/pec.0000000000002651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Acute bacterial meningitis (ABM) continues to be a challenge from a diagnostic and therapeutic point of view. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcome. METHODS Data from a retrospective study for ABM in children admitted to the Institute of Tropical Medicine in Paraguay was analyzed. ABM was defined as positive cerebrospinal fluid culture, positive latex agglutination, or identification of microorganism by real time-polymerase chain reaction. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed. A point-based scoring system that included variables, which were clearly different among those who passed away, was constructed. RESULTS One hundred fourteen children hospitalized with ABM were eligible for the study. The mean age was 46 ± 57 months (range, 1-192 months). The observed mortality was 33% (38/114 patients). When a point-based scoring system was used, for score of 0 (n = 29) and 1 (n = 12), no death was observed. Among patients with a score of 2 (n = 14), 3 (n = 10 patients), 4 (n = 12 patients), and 5 (n = 13 patients), the mortality rate was 14.3%, 40%, 50%, and 53.8%, respectively. When the score was 6 or higher, the mortality rate was at least 63.6%. CONCLUSIONS The present score accurately discriminated the probability of death in children hospitalized with ABM, and it could be a useful tool to select candidates for admission to the intensive care unit and for adjunctive therapy in clinical trials.
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12
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Tavakoli H, Hirth E, Luo M, Sharma Timilsina S, Dou M, Dominguez DC, Li X. A microfluidic fully paper-based analytical device integrated with loop-mediated isothermal amplification and nano-biosensors for rapid, sensitive, and specific quantitative detection of infectious diseases. LAB ON A CHIP 2022; 22:4693-4704. [PMID: 36349548 PMCID: PMC9701502 DOI: 10.1039/d2lc00834c] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Bacterial meningitis, an infection of the membranes (meninges) and cerebrospinal fluid (CSF) surrounding the brain and spinal cord, is one of the major causes of death and disability worldwide. Higher case-fatality rates and short survival times have been reported in developing countries. Hence, a quick, straightforward, and low-cost approach is in great demand for the diagnosis of meningitis. In this research, a microfluidic fully paper-based analytical device (μFPAD) integrated with loop-mediated isothermal amplification (LAMP) and ssDNA-functionalized graphene oxide (GO) nano-biosensors was developed for the first time for a simple, rapid, low-cost, and quantitative detection of the main meningitis-causing bacteria, Neisseria meningitidis (N. meningitidis). The results can be successfully read within 1 hour with the limit of detection (LOD) of 6 DNA copies per detection zone. This paper device also offers versatile functions by providing a qualitative diagnostic analysis (i.e., a yes or no answer), confirmatory testing, and quantitative analysis. These features make the presented μFPAD capable of a simple, highly sensitive, and specific diagnosis of N. meningitis. Furthermore, this microfluidic approach has great potential in the rapid detection of a wide variety of different other pathogens in low-resource settings.
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Affiliation(s)
- Hamed Tavakoli
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
| | - Elisabeth Hirth
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
- Department of Chemistry, University of Aalen, Beethovenstraße 1, 73430 Aalen, Germany
| | - Man Luo
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
| | - Sanjay Sharma Timilsina
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
| | - Maowei Dou
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
| | - Delfina C Dominguez
- College of Health Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - XiuJun Li
- Department of Chemistry and Biochemistry, University of Texas at El Paso, El Paso, Texas, 79968, USA.
- Border Biomedical Research Center, Biomedical Engineering, University of Texas at El Paso, El Paso, 79968, USA
- Environmental Science and Engineering, University of Texas at El Paso, El Paso, 79968, USA
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13
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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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14
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Nguyen-Huu CD, Bui-Binh-Bao S, Tran KH, Mai VT, Nguyen-Thi DC, Tran-Thi HC, Nguyen-Duy-Nam A, To P, Ton-Nu VA. Main Clinical and Laboratory Features of Children with Bacterial Meningitis: Experience from a Tertiary Paediatric Centre in Central Vietnam. Pediatric Health Med Ther 2022; 13:289-295. [PMID: 36051354 PMCID: PMC9427117 DOI: 10.2147/phmt.s371914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Chau Duc Nguyen-Huu
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Son Bui-Binh-Bao
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Kiem Hao Tran
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
| | - Van Tuan Mai
- Microbiology Department, Hue Central Hospital, Hue City, Vietnam
| | | | | | - Anh Nguyen-Duy-Nam
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Phuc To
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Van Anh Ton-Nu
- Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
- Correspondence: Van Anh Ton-Nu, Department of Pediatrics, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen St, Hue City, 49000, Vietnam, Tel +84 234 3822173, Fax +84 234 3826269, Email
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15
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Risk Factors for Severe Outcomes in Bacterial Meningitis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-110134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study aimed to define risk factors associated with suppurative complications, short-term sequelae, and death in pediatric patients with bacterial meningitis. Methods: A retrospective cohort study was conducted on children with bacterial meningitis, aged 0 months to 18 years, who were admitted to the Hospital Infantil João Paulo II, reference in infectious diseases, from 2005 to 2018. Results: In 178 cases, meningococcal meningitis was the most prevalent disease form (51%), followed by pneumococcal meningitis (31%) and Haemophilus influenzae type B meningitis (10%). The main clinical findings at admission were fever (93.1%), vomiting (67.9%), drowsiness (47.8%), headache (36.5%), irritability (28.3%), and seizures (26.4%). Suppurative complications were recorded in 19% of the patients. The prevalence of neurological sequelae during hospital discharge was 12.4%. Hearing (41%; n = 9) and cognitive (9%) impairments were prominent among the diagnosed sequelae. Incidences of epileptic crises, vestibular disorders, or hydrocephalus were noted in one case each (4.5%), and 12.4% of the patients died. Conclusions: Streptococcus pneumoniae and H. influenzae type B were associated with the diagnosis of sequelae during hospital discharge, seizures were considered a risk factor for suppurative complications, and gastrointestinal symptoms or signs of clinical severity were associated with death.
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16
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Li X, Du H, Song Z, Wang H, Long X. Polymicrobial Anaerobic Meningitis Detected by Next-Generation Sequencing: Case Report and Review of the Literature. Front Med (Lausanne) 2022; 9:840910. [PMID: 35273982 PMCID: PMC8902384 DOI: 10.3389/fmed.2022.840910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
Background Anaerobic meningitis is a severe central nervous system infection associated with significant neurological sequelae and high mortality. However, the precise detection of causative pathogen(s) remains difficult because anaerobic bacteria are difficult to culture. Next-generation sequencing is a technology that was developed recently and has been applied in many fields. To the best of our knowledge, the use of next-generation sequencing for cerebrospinal fluid analysis in the diagnosis of anaerobic meningitis has been rarely reported. Case presentation Here, we report a case of polymicrobial anaerobic meningitis diagnosed using next-generation sequencing of cerebrospinal fluid in a 16-year-old girl. Five species of anaerobic bacteria (Porphyromonas gingivalis, Prevotella enoeca, Campylobacter rectus, Fusobacterium uncleatum, and Actinomyces israelii) were detected by next-generation sequencing and treated with antibacterial agents (ceftriaxone, vancomycin, and metronidazole). The patient responded well to antibacterial treatment. Further inspection revealed bone destruction at the base of the skull, which further confirmed that these bacteria had originated from the oral cavity. One month later, the patient's condition improved significantly. At the same time, we performed a literature review on anaerobic meningitis using studies published in the last 20 years. Conclusions This case emphasizes the importance of applying metagenomic next-generation sequencing to clinch the clinical diagnosis for patients with central nervous system infection. Metagenomic next-generation sequencing has been reported to be an important diagnostic modality for identifying uncommon pathogens.
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Affiliation(s)
- Xiaoqiang Li
- Department of Neurology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Hui Du
- Department of Clinical Laboratory Center, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Zhibin Song
- Department of Neurology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Hui Wang
- Department of Neurology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Xiong Long
- Emergency Department, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
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Shi K, Purser JS, Germiller JA, Rampton JW, Firpo MA, Park AH. Gadolinium-based contrast agent for Magnetic Resonance Imaging as a predictor of postmeningitic hearing loss in children. Int J Pediatr Otorhinolaryngol 2021; 150:110936. [PMID: 34700237 DOI: 10.1016/j.ijporl.2021.110936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/14/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine if Gadolinium-based enhanced Magnetic Resonance Imaging (GdMRI) can be used to predict sensorineural hearing loss (SNHL) in pediatric patients diagnosed with bacterial meningitis. STUDY Design: Retrospective chart review. SETTING Primary Children's Hospital, Salt Lake City, Utah. SUBJECTS and Methods: We studied forty-two pediatric patients diagnosed with bacterial meningitis who underwent brain GdMRI during their index hospital admission and for whom ear specific audiometric data were available (August 2008-July 2018). A pediatric neuroradiologist, blinded to both disease and audiometric data, rated cochlear enhancement of each GdMRI (0-3; none to markedly enhanced). RESULTS Ear specific MRI scores were statistically significantly related to ear specific hearing outcomes (p < 0.01). SNHL occurred in 19 out of 82 ears (12 out of 42 patients; 2 ears were excluded due to pre-existing SNHL in one ear and inability to read the GdMRI on the other ear). Ten of 19 ears (53%) that developed SNHL showed mild/moderate/marked enhancement (MRI score of 1, 2, or 3 respectively). Fifty-three of the 63 unaffected ears (84%) showed no enhancement (MRI score of 0). Ten of 13 (77%) ears that developed severe to profound SNHL showed mild/moderate/marked enhancement. GdMRI was 58% sensitive and 84% specific in predicting which ears would develop SNHL. GdMRI was 77% sensitive and 84% specific in identifying severe to profound SNHL. CONCLUSION Our study demonstrates that GdMRI is a promising tool for predicting specifically severe-profound hearing loss in pediatric patients following bacterial meningitis infection.
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Affiliation(s)
- Kevin Shi
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy S Purser
- Texas A&M University Health and Science Center, Bryan, TX, USA
| | - John A Germiller
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - John W Rampton
- Pediatric Radiology, Intermountain Medical Group, Salt Lake City, UT, USA
| | - Matthew A Firpo
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Albert H Park
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.
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18
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Haffner DN, Machie M, Hone E, Said RR, Maitre NL. Predictors of Neurodevelopmental Impairment After Neonatal Bacterial Meningitis. J Child Neurol 2021; 36:968-973. [PMID: 34256644 DOI: 10.1177/08830738211026053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neonatal bacterial meningitis has high rates of morbidity and mortality. Early clinical signs and neuroimaging suggest adverse outcomes, but little is known about their combined predictive properties. We evaluated the combination of findings most associated with death and neurodevelopmental impairment. METHODS Single-center retrospective cohort study of term and late preterm neonates with bacterial meningitis. Predictors of death and neurodevelopmental impairment were identified on univariate analysis and incorporated into Lasso models to identify variables best predicting adverse outcomes. RESULTS Of 103 neonates, 6 died acutely; 30% of survivors had neurodevelopmental impairment. Clinical variables (seizures, pressor support) predicted death and neurodevelopmental impairment better than the neuroimaging or combined findings (area under the curve 0.88 vs 0.79 and 0.83, respectively). Among survivors, neuroimaging findings (cerebrovascular lesions, ventriculomegaly) predicted neurodevelopmental impairment better than clinical or combined findings (area under the curve 0.82 vs 0.80 and 0.77, respectively). CONCLUSIONS Seizures are important predictors of adverse outcomes in neonatal bacterial meningitis. Among survivors, neuroimaging findings help predict neurodevelopmental impairment.
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Affiliation(s)
- Darrah N Haffner
- Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA.,Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical School/Children's Health, Dallas, TX, USA
| | - Michelle Machie
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical School/Children's Health, Dallas, TX, USA
| | - Emily Hone
- Biostatistics Core, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rana R Said
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical School/Children's Health, Dallas, TX, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
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Kim BG, Jang MS, Kim J. Epidemiology of Pediatric Meningitis in South Korea From 2010 to 2018: A Population-based Retrospective Cohort Study. Pediatr Infect Dis J 2021; 40:885-891. [PMID: 33990524 DOI: 10.1097/inf.0000000000003190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies evaluating the epidemiology of pediatric meningitis are limited in our region. This study aimed to describe recent trends in the incidence of pediatric meningitis. METHODS We estimated national trends in hospitalization rates for pediatric meningitis (<18 years) by analyzing data from the Health Insurance Review and Assessment database between 2010 and 2018. Meningitis cases were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes and hospitalization rates were calculated. RESULTS In this national population-based study, a total of 119,644 hospitalizations and 58 deaths due to pediatric meningitis were identified. The hospitalization rates of pediatric bacterial meningitis have declined by 50.0%, from 3.4 per 100,000 in 2010 to 1.7 per 100,000 in 2018. The mortality rates for bacterial and viral meningitis were 2.0% and 0.002%, respectively. Despite the decreased annual incidence of bacterial meningitis, its mortality rate did not change significantly during the study period. The only risk factor identified for mortality in bacterial meningitis patients among age group, sex, region of residence, and season was age below 1 year (P < 0.001). As children under 1 year have a high-mortality rate (4.2%), patients in this age group require close monitoring. The reasons behind indistinct seasonal patterns of bacterial meningitis warrant further investigation. CONCLUSIONS Childhood bacterial meningitis has shown a significant decline in incidence from 2010 to 2018. In contrast, viral meningitis has not shown a trend over time. Knowledge of these changes may aid clinicians in the decision-making process and management of meningitis patients.
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Affiliation(s)
- Bit Gyeol Kim
- From the Department of Pediatrics, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul, Republic of Korea
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20
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Maria de França G, Andrade ACDM, Felix FA, da Silva WR, Almeida DRDMF, Leite RB, Galvão HC, Miguel MCDC. Survival-related epithelial-mesenchymal transition proteins in oropharyngeal squamous cell carcinoma: A systematic review and meta-analysis. Arch Oral Biol 2021; 131:105267. [PMID: 34592489 DOI: 10.1016/j.archoralbio.2021.105267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To aim of this systematic review was to explore the relationship between Human papillomavirus (HPV) and epithelial-mesenchymal transition (EMT) related to the prognosis of oropharyngeal squamous cell carcinoma (OPSCC). DESIGN For this systematic review, searches were performed in PubMed, Web of Science, Scopus, Science Direct, and Cochrane, and a random-effects model was used for meta-analysis. The presence of EMT was confirmed by the loss of E-cadherin immunoexpression and overexpression of vimentin. RESULTS In summary, EMT-related proteins were expressed regardless of HPV status; however, overall survival was better in HPV-positive OPSCC cases, with a 5.88 times lower death risk compared to HPV-negative patients (OR=0.17; 95%CI=0.10-0.30). Likewise, the maintenance of E-cadherin in OPSCC was associated with an 11.11 times lower risk of death due to the disease (OR=0.09; 95%CI=0.01-0.88). CONCLUSIONS More advanced clinical stages (III/IV) and the presence of lymph node metastases (N1-3) were common in OPSCC but were not significantly associated with HPV status.
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Affiliation(s)
- Glória Maria de França
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Ana Claudia de Macedo Andrade
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Fernanda Aragão Felix
- Postgraduate Program in Dental Sciences, Concentration Area in Experimental Biology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Weslay Rodrigues da Silva
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Rafaella Bastos Leite
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Hébel Cavalcanti Galvão
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Márcia Cristina da Costa Miguel
- Postgraduate Program in Dental Sciences, Concentration Area in Oral Pathology and Stomatology, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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21
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Lal SN, Maria A, Bandyopadhyay T. Antimicrobial Resistance and Predictors of Adverse Outcomes in Neonates with Bacterial Meningitis: a Retrospective Study from a Tertiary Care Hospital of Northern India. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1732347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThis study aimed to determine antimicrobial resistance pattern and predictors of adverse outcome in neonatal meningitis. A retrospective study by analyzing case files of 134 cases of neonatal meningitis. We noted an alarming degree of multidrug resistance (MDR) among both gram-negative (Klebsiella spp., 50%; Escherichia coli, 100%; and and Acinetobacter spp., 50%), as well as positive (Enterococcus, 100%) isolates in cerebrospinal fluid (CSF) culture. The incidence rate of adverse outcome (i.e., mortality and abnormal neurological examination at discharge) was 8.2 and 17.2%, respectively. On univariate analysis, delayed seeking of medical care, bulging anterior fontanelle, vomiting, positive sepsis screen, shock during hospital course, ventriculitis, diversion procedures for raised intracranial pressure, central line placement, low CSF sugar, and failed hearing screening test at discharge were associated with increased risk of adverse outcome. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MDR infections were independently found to be associated with adverse outcomes. An alarming degree of antimicrobial resistance among the CSF isolates necessitates the need to understand the pathogenesis of resistance and curtail the irrational prescription of antibiotics in neonatal meningitis. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MRD infection may have prognostic value in neonatal meningitis
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Affiliation(s)
- Sandeep N. Lal
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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22
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Zheng H, Glauser J. Review and Updates on Pediatric Fever. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021. [DOI: 10.1007/s40138-021-00227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bacterial Meningitis in Children: Neurological Complications, Associated Risk Factors, and Prevention. Microorganisms 2021; 9:microorganisms9030535. [PMID: 33807653 PMCID: PMC8001510 DOI: 10.3390/microorganisms9030535] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 01/07/2023] Open
Abstract
Bacterial meningitis is a devastating infection, with a case fatality rate of up to 30% and 50% of survivors developing neurological complications. These include short-term complications such as focal neurological deficit and subdural effusion, and long-term complications such as hearing loss, seizures, cognitive impairment and hydrocephalus. Complications develop due to bacterial toxin release and the host immune response, which lead to neuronal damage. Factors associated with increased risk of developing neurological complications include young age, delayed presentation and Streptococcus pneumoniae as an etiologic agent. Vaccination is the primary method of preventing bacterial meningitis and therefore its complications. There are three vaccine preventable causes: Haemophilus influenzae type b (Hib), S. pneumoniae, and Neisseria meningitidis. Starting antibiotics without delay is also critical to reduce the risk of neurological complications. Additionally, early adjuvant corticosteroid use in Hib meningitis reduces the risk of hearing loss and severe neurological complications.
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TLR9 Rs352140 polymorphism contributes to a decreased risk of bacterial meningitis: evidence from a meta-analysis. Epidemiol Infect 2020; 148:e294. [PMID: 33143777 PMCID: PMC7770465 DOI: 10.1017/s0950268820002666] [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] [Indexed: 11/07/2022] Open
Abstract
Some studies have suggested that the Toll-like receptor 9 polymorphism (TLR9 rs352140) is closely related to the risk of bacterial meningitis (BM), but this is subject to controversy. This study set out to estimate whether the TLR9 rs352140 polymorphism confers an increased risk of BM. Relevant literature databases were searched including PubMed, Embase, the Cochrane Library and China National Knowledge Infrastructure (CNKI) up to August 2020. Seven case-control studies from four publications were enrolled in the present meta-analysis. Odds ratios (OR) and confidence intervals (95% CI) were calculated to estimate associations between BM risk and the target polymorphism. Significant associations identified were allele contrast (A vs. G: OR 0.66, 95% CI 0.59–0.75, P = 0.000), homozygote comparison (AA vs. AG/GG: OR 0.62, 95% CI 0.49–0.78, P = 0.000), heterozygote comparison (A vs. G: OR 0.74, 95% CI 0.61–0.91, P = 0.005), recessive genetic model (AA vs. AG/GG: OR 0.78, 95% CI 0.65–0.93, P = 0.006) and dominant genetic model (AA vs. AG/GG: OR 0.70, 95% CI 0.57–0.85, P = 0.000). The findings indicate that, in contrast to some studies, the TLR9 rs352140 polymorphism is associated with a decreased risk for BM.
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Agossou J, Ebruke C, Noudamadjo A, Adédémy JD, Dènon EY, Bankolé HS, Dogo MA, Assogba R, Alassane M, Condé A, Mohamed FA, Kpanidja G, Gomina M, Hounsou F, Aouanou BG, Okoi C, Oluwalana C, Worwui A, Ndow PS, Nounagnon J, Mwenda JM, Sossou RA, Kwambana-Adams BA, Antonio M. Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016. Clin Infect Dis 2020; 69:S140-S147. [PMID: 31505630 PMCID: PMC6761314 DOI: 10.1093/cid/ciz478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011-2016. METHODS Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. RESULTS A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0-11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08-24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. CONCLUSIONS The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.
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Affiliation(s)
- Joseph Agossou
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Chinelo Ebruke
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Alphonse Noudamadjo
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Julien D Adédémy
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Eric Y Dènon
- Service National de Laboratoire Sante Publique, Cotonou
| | | | - Mariam A Dogo
- Service National de Laboratoire Sante Publique, Cotonou
| | | | | | - Abdoullah Condé
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Falilatou Agbeille Mohamed
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Gérard Kpanidja
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | | | | | - Basile G Aouanou
- Service National de Laboratoire Sante Publique, Cotonou.,Saint Jean de Dieu Hospital of Tanguieta, Benin
| | - Catherine Okoi
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Claire Oluwalana
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Peter S Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Factors associated with early complications in inpatients who were treated in our clinic between 1992 and 2011 with a diagnosis of acute bacterial meningitis. TURK PEDIATRI ARSIVI 2020; 55:149-156. [PMID: 32684760 PMCID: PMC7344122 DOI: 10.14744/turkpediatriars.2019.34445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022]
Abstract
Aim: To evaluate factors associated with the development of early complications in acute bacterial meningitis. Material and Methods: In our study, 389 patients diagnosed with acute bacterial meningitis between January 1992 and January 2011 at Cerrahpaşa Medical Faculty were retrospectively analyzed to determine the risk factors for the development of early complications. Results: The causative agent was N. meningitidis in 17% of cases, S. pneumoniae in 13.6%, and H. influenzae type b in 6.4%. In 55.5% of cases, the causative agent could not be identified. The mortality rate was found as 1% and the early complication rate was 27.8%. The complications observed included septic shock and disseminated intravascular coagulation (33.3%), hydrocephalus (23.1%), subdural effusion (19.4%), and epilepsy (12%). Risk factors for early complications included being aged below two years (p<0.010), restlessness (p<0.010), rash (p<0.010), leukocytosis in complete blood count (p<0.010), and a cerebrospinal fluid glucose level of <45 mg/dL (p<0.010). Three of the four patients who died were male. The incidence of hydrocephalus was higher in patients who used ampicillin-cefotaxime and who did not receive steroid therapy before treatment (p<0.050). Conclusion: When acute bacterial meningitis is treated properly and adequately, recovery without sequela is possible. Knowing the risk factors for early complications will guide in the monitoring of patients and decrease morbidity and mortality rates.
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De Almeida SM, Barros NC, Petterle R, Nogueira K. Comparison of cerebrospinal fluid lactate with physical, cytological, and other biochemical characteristics as prognostic factors in acute bacterial meningitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:871-880. [PMID: 31939584 DOI: 10.1590/0004-282x20190185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/13/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Bacterial meningitis (BM) is associated with a high morbidity and mortality. Cerebrospinal fluid (CSF) lactate may be used as a prognostic marker of this condition. We hypothesized that CSF lactate levels would remain elevated in participants who died of acute BM compared with those who recovered from this disease. To evaluate the potential use of lactate and other CSF biomarkers as prognostic markers of acute BM outcome. METHODS This retrospective, longitudinal study evaluated dynamic CSF biomarkers in 223 CSF samples from 49 patients who fulfilled the inclusion criteria of acute BM, with bacteria identified by CSF culturing. The participants were grouped according to outcome: death (n = 9; 18.37%) and survival (n = 40; 81.63%). All participants received appropriate antibiotic treatment. RESULTS In the logistic regression model, lactate concentration in the final CSF sample, xanthochromia, and CSF glucose variation between the first and last CSF samples were predictors of a poor outcome (death). In contrast, decrease in CSF white blood cell count and CSF percentage of neutrophils, increase in the percentage of lymphocytes, and normalization of the CSF lactate concentration in the last CSF sample were predictors of a good prognosis. CONCLUSION The study confirmed the initial hypothesis. The longitudinal analysis of CSF lactate is an important predictor of prognosis in acute BM.
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Affiliation(s)
| | - Nagyla C Barros
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
| | - Ricardo Petterle
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
| | - Keite Nogueira
- Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brasil
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Sex-specific stress response and HMGB1 release in pulmonary endothelial cells. PLoS One 2020; 15:e0231267. [PMID: 32271800 PMCID: PMC7145198 DOI: 10.1371/journal.pone.0231267] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/05/2020] [Indexed: 01/03/2023] Open
Abstract
Women are known to be associated with a higher susceptibility to pulmonary arterial hypertension (PAH). In contrast, male PAH patients have a worse survival prognosis. In this study, we investigated whether the contribution of sex goes beyond the effects of sex hormones by comparing the ability of isolated male and female pulmonary endothelial cells to respire, proliferate and tolerate the stress. Mouse lung endothelial cells (MLEC) were isolated from the lungs of male and female 3-week old mice. Male MLEC showed an increased basal mitochondrial respiration rate, elevated maximal respiration, a significantly greater level of mitochondrial polarization, and a higher rate of proliferation. Exposure of cells to hypoxia (2% of O2 for 24 hours) induced a strong apoptotic response in female but not male MLEC. In contrast, treatment with mitochondrial respiratory Complex III inhibitor Antimycin A (AA, 50μM) mediated severe necrosis specifically in male MLEC, while female cells again responded primarily by apoptosis. The same effect with female cells responding to the stress by apoptosis and male cells responding by necrosis was confirmed in starved pulmonary endothelial cells isolated from human donors. Elevated necrosis seen in male cells was associated with a significant release of damage-associated alarmin, HMGB1. No stimuli induced a significant elevation of HMGB1 secretion in females. We conclude that male cells appear to be protected against mild stress conditions, such as hypoxia, possibly due to increased mitochondrial respiration. In contrast, they are more sensitive to impaired mitochondrial function, to which they respond by necrotic death. Necrosis in male vascular cells releases a significant amount of HMGB1 that could contribute to the pro-inflammatory phenotype known to be associated with the male gender.
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Johansson Kostenniemi U, Karlsson L, Silfverdal SA, Mehle C. MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis. Neurocrit Care 2020; 32:586-595. [PMID: 31342450 PMCID: PMC7082372 DOI: 10.1007/s12028-019-00792-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowing the individual child's risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors. METHODS We developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC). Finally, we tested all predictive scores at their cut-off levels using a Chi-square test. As outcome, we used a small number of predefined outcomes; in-hospital mortality, 30-day mortality, occurrence of neurological disabilities at discharge defined as Pediatric Cerebral Performance Category Scale category two to five, any type of complications occurring during the hospital stay, use of intensive care, and use of invasive procedures to monitor or manage the intracerebral pressure. RESULTS For identifying children later undergoing invasive procedures to monitor or manage the intracerebral pressure, the MeningiSSS excelled in the ROC-analysis (AUC = 0.90) and also was the only predictive score able to identify all cases at its cut-off level (25 vs 0%, p < 0.01). For intensive care, the MeningiSSS (AUC = 0.79) and the Simple Luanda Scale (AUC = 0.75) had the best results in the ROC-analysis, whereas others performed less well (AUC ≤ 0.65). Finally, while none of the scores' results were significantly associated with complications, an elevated score on the MeningiSSS (AUC = 0.70), Niklasson Scale (AUC = 0.72), and the Herson-Todd Scale (AUC = 0.79) was all associated with death. CONCLUSIONS The MeningiSSS outperformed existing predictive scores at identifying children later having to undergo invasive procedures to monitor or manage the intracerebral pressure in children with bacterial meningitis. Our results need further external validation before use in clinical practice. Thus, the MeningiSSS could potentially be helpful when making difficult decisions concerning intracerebral pressure management.
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MESH Headings
- Age Factors
- Area Under Curve
- Body Temperature
- Child, Preschool
- Critical Care
- Decision Support Systems, Clinical
- Decompressive Craniectomy
- Drainage
- Female
- Functional Status
- Haemophilus Infections/complications
- Haemophilus Infections/physiopathology
- Haemophilus Infections/therapy
- Hospital Mortality
- Humans
- Intracranial Hypertension/diagnosis
- Intracranial Hypertension/etiology
- Intracranial Hypertension/physiopathology
- Intracranial Hypertension/therapy
- Intracranial Pressure
- Leukopenia/physiopathology
- Male
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/physiopathology
- Meningitis, Bacterial/therapy
- Meningitis, Meningococcal/complications
- Meningitis, Meningococcal/physiopathology
- Meningitis, Meningococcal/therapy
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/physiopathology
- Meningitis, Pneumococcal/therapy
- Monitoring, Physiologic
- Mortality
- ROC Curve
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/physiopathology
- Risk Factors
- Seizures/etiology
- Seizures/physiopathology
- Shock/etiology
- Shock/physiopathology
- Ventriculostomy
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Affiliation(s)
- Urban Johansson Kostenniemi
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87, Umeå, Sweden.
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden.
| | - Linda Karlsson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Sven-Arne Silfverdal
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87, Umeå, Sweden
| | - Christer Mehle
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
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Teixeira DC, Diniz LMO, Guimarães NS, Moreira HMDAS, Teixeira CC, Romanelli RMDC. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Teixeira DC, Diniz LMO, Guimarães NS, Moreira HMDAS, Teixeira CC, Romanelli RMDC. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. J Pediatr (Rio J) 2020; 96:159-167. [PMID: 31437421 PMCID: PMC9432045 DOI: 10.1016/j.jped.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" METHODS The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. RESULTS The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. CONCLUSIONS Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.
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Affiliation(s)
- Daniela Caldas Teixeira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil.
| | - Lilian Martins Oliveira Diniz
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil; Faculdade de Medicina de Barbacena, Barbacena, MG, Brazil
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Evolution of Different Bacterial Mningoencephalitis: Series of Case Presentations and Literature Review. ARS MEDICA TOMITANA 2020. [DOI: 10.2478/arsm-2019-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Bacterial meningitis is one of the most important medical emergencies, a life-threatening condition that leads to death in all the cases in untreated patients. In infants and young children, especially under 5 years old, the most encountered and severe forms are caused by Streptococcus pneumoniae, Neisseria meningitidis and Hemophilus influenzae type b. The risk of neurological impairment after an acute episode of bacterial meningitis is relatively high. Worldwide, prevention through vaccination decreased dramatically incidence and mortality related to these disease. In Romania vaccination for Neisseria meningitides is optional available for just 6 months, vaccination for Streptococcus pneumoniae by one year, and for Haemophylus influenzae type B is available over 10 years.
We present evolution of a series of three cases with different bacterial meningoencephalitis with severe evolution and prolonged hospitalization. All these cases were reported in unvaccinated children for germs that cause meningitis.
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Svendsen MB, Ring Kofoed I, Nielsen H, Schønheyder HC, Bodilsen J. Neurological sequelae remain frequent after bacterial meningitis in children. Acta Paediatr 2020; 109:361-367. [PMID: 31325195 DOI: 10.1111/apa.14942] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/30/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
AIM To examine the incidence, clinical presentation and risk factors for neurological sequelae following childhood community-acquired bacterial meningitis (CABM). METHODS We included all children aged 1 month to 15 years old with CABM in North Denmark Region, 1998-2016. Using medical records, we registered baseline demographics, signs and symptoms at admission, laboratory investigations, and outcome assessed by the Glasgow Outcome Scale (GOS). A GOS score of 1-4 was considered an unfavourable outcome. We used modified Poisson regression to examine predefined risk factors for neurological sequelae among survivors. RESULTS We identified 88 cases of CABM in 86 patients (45 female) with a median age of 1.4 years (interquartile range 0.7-4.6). Neisseria meningitidis was the most common pathogen (48/88). Neurological sequelae occurred in 23 (27%) as hearing deficits in 13 (15%), cognitive impairment in 10 (12%) and motor or sensory nerve deficits in 8 (9%). Unfavourable outcome was observed in 16 (18%) patients and three (3%) patients died. Abnormalities on cranial imaging remained the only independent risk factor for developing neurological sequelae in adjusted analysis. CONCLUSION Neurological sequelae following CABM in children remain frequent and abnormal cranial imaging may be an independent risk factor.
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Affiliation(s)
- Morten B. Svendsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
| | - Inge Ring Kofoed
- Department of Paediatrics Aalborg University Hospital Aalborg Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Department of Clinical Microbiology Aalborg University Hospital Aalborg Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases Aalborg University Hospital Aalborg Denmark
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Abuga JA, Kariuki SM, Kinyanjui SM, Boele Van Hensbroek M, Newton CR. Premature mortality in children aged 6-9 years with neurological impairments in rural Kenya: a cohort study. Lancet Glob Health 2019; 7:e1728-e1735. [PMID: 31653591 PMCID: PMC7024990 DOI: 10.1016/s2214-109x(19)30425-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/16/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurological impairments might significantly contribute to reduced life expectancy in low-income and middle-income countries (LMICs). There are no empirical studies of premature mortality in children with neurological impairments in Africa. This study estimated the risk of premature mortality in children with neurological impairments and identified risk factors and causes of death. METHODS We did a cohort study based on a two-stage epidemiological survey in the Kilifi Health and Demographic Surveillance System (Kilifi, Kenya). Study participants were children aged 6-9 years. In the first stage, five trained field workers administered a low-cost screening tool to a random sample of households. In the second stage, we assessed for neurological impairments in five domains (epilepsy, cognitive impairments, vision impairments, hearing impairments, and motor impairments) using comprehensive clinical evaluation and extensive neuropsychological assessments. From the two-stage survey we identified a cohort of children with neurological impairment and a cohort of matched controls. We also enrolled an age-matched sample from the general population. The primary outcome was all-cause mortality. Mortality rates, standardised mortality ratio (SMR), and hazard ratios (HR) for risk factors were estimated and causes of death identified. FINDINGS We enrolled 306 children with neurological impairment, 9912 survey controls, and 22 873 age-matched participants from the general population, and followed up the cohorts between June 1, 2001, and Aug 31, 2018. Median follow-up was 14·5 years (IQR 8·6-17·2). 11 (3·9%) of 284 children with neurological impairment, 92 (1·0%) of 9009 controls, and 272 (1·2%) of 22 873 participants in the general population sample died during the follow-up. Overall mortality rates were 309·8 per 100 000 person-years of observation (95% CI 126·7-492·9) in children with neurological impairment, 80·8 per 100 000 person-years of observation (64·3-97·3) in controls, and 98·8 per 100 000 person-years of observation (87·1-110·6) in the general population sample (mortality rate ratio 3·83, 95% CI 2·05-7·16, p<0·001, compared with controls; 3·13, 1·71-5·72, p<0·001, compared with the general population). Mortality risk in children with neurological impairment was not dependent on the severity of impairment (p=0·291) nor on a specific neurological impairment domain (p=0·205). The overall risk of death adjusted for age and sex was higher in children with neurological impairment compared with controls (HR 4·24, 95% CI 2·26-7·94, p=0·002). An SMR of 3·15 (95% CI 1·66-5·49) was obtained after using the general population sample as the reference for indirect standardisation. In multivariable risk factor analysis, developmental delay (adjusted HR 18·92, 95% CI 2·23-160·44, p=0·007) and severe malnutrition (20·92, 3·14-139·11, p=0·002) increased the risk of mortality in children with neurological impairment. Infections such as HIV/AIDS and accidents were common among all decedents. INTERPRETATION The risk of premature mortality was higher in children diagnosed with neurological impairments compared with the general population and was increased by developmental delay and severe malnutrition. Child development and nutritional status should be assessed in all children in LMICs and tailored interventions started to improve outcomes. FUNDING Wellcome Trust, DELTAS Africa Initiative.
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Affiliation(s)
- Jonathan A Abuga
- Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Netherlands; Department of Public Health, Kisii University, Kisii, Kenya.
| | - Symon M Kariuki
- Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Samson M Kinyanjui
- Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Pwani University, Kilifi, Kenya
| | - Michaël Boele Van Hensbroek
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Netherlands
| | - Charles Rjc Newton
- Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Pwani University, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
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Ramgopal S, Walker LW, Vitale MA, Nowalk AJ. Factors associated with serious bacterial infections in infants ≤60 days with hypothermia in the emergency department. Am J Emerg Med 2019; 37:1139-1143. [DOI: 10.1016/j.ajem.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023] Open
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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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Mao DH, Miao JK, Zou X, Chen N, Yu LC, Lai X, Qiao MY, Chen QX. Risk Factors in Predicting Prognosis of Neonatal Bacterial Meningitis-A Systematic Review. Front Neurol 2018; 9:929. [PMID: 30515129 PMCID: PMC6255960 DOI: 10.3389/fneur.2018.00929] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/12/2018] [Indexed: 02/03/2023] Open
Abstract
Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis. Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis. Studies published from the initiation of the database to April 30th, 2017 were included. The quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). The quality of cross-section studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) scale. Each prognostic factor known to cause adverse outcomes is summarized. Results: Sixteen studies were identified, including 7 cohort studies and 9 cross section studies. Seizure and high protein levels in the cerebrospinal fluid (CSF) predict a poor prognosis in this disease. Coma, the need for ventilation support, and leukopenia also had some value for predicting poor prognoses. A bulging anterior fontanelle was valuable for predicting mortality. Low CSF glucose levels, thrombocytopenia, gestational age (GA) < 37 weeks and an altered sensorium were correlated with a poor prognosis. A birth weight < 2500 g, early onset meningitis and positive CSF cultures were correlated with mortality. Conclusions: This study provides a preliminary exploration of prognostic factors in neonatal bacterial meningitis and thereby fills some of the gaps in the study of prognoses in this disease. These prognostic factors can be used to predict and estimate outcomes in neonatal bacterial meningitis. Without a meta-analysis, the reliability of these factors cannot be assured. In addition, these results emphasize that there is an urgent need for a standardized protocol for follow-up and well-designed prognostic studies in neonatal bacterial meningitis.
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Affiliation(s)
- Dan-Hua Mao
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Jing-Kun Miao
- Chongqing International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
| | - Xian Zou
- Chongqing International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, China
| | - Na Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lin-Chao Yu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xin Lai
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Meng-Yuan Qiao
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi-Xiong Chen
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
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Wang Y, Liu X, Liu Q. NOD2 Expression in Streptococcus pneumoniae Meningitis and Its Influence on the Blood-Brain Barrier. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2018; 2018:7292084. [PMID: 30186539 PMCID: PMC6109993 DOI: 10.1155/2018/7292084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 02/07/2023]
Abstract
Streptococcus pneumoniae meningitis is one of the most common disorders seen in clinical practice. It is believed that the brain tissue immune injury is caused by the expression of pattern-recognition receptors (PRR) which can further induce the release of other cytokines and inflammatory cascades. The aim of this study is to investigate the expression of nucleotide-binding oligomerization domain 2 (NOD2) and inflammatory factors in rat brain tissues infected with Streptococcus pneumoniae and its influence on the blood-brain barrier (BBB) permeability. Rats were given an intracranial injection of Streptococcus pneumoniae to construct the Streptococcus pneumoniae meningitis rat models. The expression change curves of NOD2 and inflammatory factors at different time points (0 h, 12 h, 24 h, 48 h, and 7 d) after Streptococcus pneumoniae were evaluated by enzyme-linked immunosorbent assay (ELISA). Western blotting analysis and quantitative real-time polymerase chain reaction (qRT-PCR) were engaged to examine the expression of NOD2. Furthermore, the changing processes of pathological characteristics, nervous system score, cerebral oedema, and BBB permeability were observed. Our results showed that NOD2 expression began to increase in the 12 h after Streptococcus pneumoniae infection group, while the remaining inflammatory factors were not obviously increased. Meanwhile, the levels of NOD2, as well as inflammatory factors IL-1β, TNF-α, and IL-6 were markedly elevated in 24 h and 48 h infection groups, which were consistent with the increases in BBB permeability and BWC, and the positive expression of NOD2 in the infected rat brain tissues was observed using immunohistochemistry (IHC). This study suggests that NOD2 might be related to the activation of inflammation pathways and the damage to the blood-brain barrier. NOD2 and inflammatory factors have played vital roles in the pathogenesis of Streptococcus pneumoniae meningitis.
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Affiliation(s)
- Ying Wang
- Department of Pediatrics, Qilu Hospital, Shandong University, 107# Wen Hua Xi Road, Jinan, Shandong 250012, China
- The People's Hospital in Zoucheng, 59# Qian Quan Road, Zoucheng, Shandong 273500, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital, Shandong University, 107# Wen Hua Xi Road, Jinan, Shandong 250012, China
| | - Qi Liu
- The People's Hospital in Zoucheng, 59# Qian Quan Road, Zoucheng, Shandong 273500, China
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Kumar M, Tripathi S, Kumar H, Singh SN. Predictors of Poor Outcome in Neonates with Pyogenic Meningitis in a Level-Three Neonatal Intensive Care Unit of Developing Country. J Trop Pediatr 2018; 64:297-303. [PMID: 29036732 DOI: 10.1093/tropej/fmx066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The mortality of neonatal pyogenic meningitis is reduced to 10-15%, but morbidity is unchanged. METHODS Primary objective is to determine the outcome, i.e. death or abnormal neurological examination (NE) at discharge and abnormal developmental quotient (DQ) at 3 months. Secondary objective is to find predictors of poor outcome. RESULTS In all, 89 neonates enrolled, 10 expired and 24 neonates had abnormal NE at discharge. A total of 59 neonates came for follow up, 13 had DQ < 70. Prolonged shock (odds ratio, OR: 8.28; p = 0.001), coma (OR: 4.3; p = 0.001), seizures (OR: 14; p = 0.012), mechanical ventilation (OR: 18.55; p = 0.00), orogastric feeding (OR: 2.78; p = 0.042) and electroencephalography (EEG; OR: 9.6; p = 0.00) predicted poor short-term outcome. Abnormal NE at discharge (OR: 15.6; p = 0.001), EEG (OR = 10.60; p = 0.00) and brainstem-evoked reflex audiometry (OR = 37.20, p = 0.00) predicted a low DQ at 3 months. Mortality and morbidity of neonates with Pyogenic Meningitis (PM) were similar to that in developed countries. Outcome depended on severity of the disease and NE at discharge.
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Affiliation(s)
- Mala Kumar
- Department of Paediatrics, King George's Medical University (KGMU), Lucknow, UP 226003, India
| | - Shalini Tripathi
- Department of Paediatrics, King George's Medical University (KGMU), Lucknow, UP 226003, India
| | - Himanshu Kumar
- Department of Paediatrics, King George's Medical University (KGMU), Lucknow, UP 226003, India
| | - S N Singh
- Department of Paediatrics, King George's Medical University (KGMU), Lucknow, UP 226003, India
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Mioramalala SA, Ramasy Razafindratovo RM, Rakotozanany A, Miarimbola R, Weldegebriel G, Mwenda JM, Robinson AL. Analysis of Death and Survival Factors Associated with Childhood Bacterial Meningitis at a Reference Pediatric Hospital in Antananarivo, Madagascar. JOURNAL OF IMMUNOLOGICAL SCIENCES 2018; Suppl:8-14. [PMID: 30843000 PMCID: PMC6398577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bacterial meningitis (BM) remains a global public health problem and most cases and deaths occur in Sub-Saharan Africa and especially in children less than five years old, due to a variety of factors. This study was conducted to determine the principal factors associated with death and survival of children due to BM in a typical African tertiary health facility. METHODS A retrospective case-control study of children hospitalized for BM was conducted in the University Hospital of Tsaralalàna (CHUMET). All children aged 3 to 59 months hospitalized for bacterial meningitis and confirmed by bacteriology were included. The cases were children who died from BM, and the controls were the survivors. Data was analyzed using Stata 13. RESULTS The factors associated with death were the number of siblings over 3 (14,48 [2,53 - 82,95]), overcrowding (9,31 [1,39 - 62,29]), time before hospitalization of more than five days (9,26 [1,36 - 62,92]), impaired consciousness (47,74 [6,24 - 364,96]), and meningococcal meningitis (36,68 [1,90 - 704,97]). CONCLUSION These factors are mainly indicators of low socioeconomic status, clinical severity of signs and particularly virulent organisms. The early detection of patients at risk allows clinicians to give them appropriate care right from admission. Further studies are necessary especially, the evaluation of the emergency care provided.
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Affiliation(s)
- Sedera Aurélien Mioramalala
- Public Health Department, Faculty of Médicine, Antananarivo, Madagascar,National Malaria Country Program, Public Health Ministry, Antananarivo, Madagascar,Correspondence: Dr. Sedera Aurélien Mioramalala, En face de l’ENAM, Androhibe – Antananarivo 101: National Malaria Country Program, Public Health Ministry, Antananarivo, Madagascar; Telephone No: +263772216853;
| | | | - Ando Rakotozanany
- Center Hospital Academic Mother Child, Public Health Ministry, Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET), Antananarivo, Madagascar
| | | | | | - Jason M Mwenda
- WHO Regional Office for Africa (WHO/AFRO), Brazzaville, Congo
| | - Annick Lalaina Robinson
- Mother and Child Department, Faculty of Medicine, Antananarivo, Madagascar,Center Hospital Academic Mother Child, Public Health Ministry, Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET), Antananarivo, Madagascar
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Sibetcheu AT, Agbor VN, Nyaga UF, Bigna JJ, Noubiap JJ. Epidemiology of heart failure in pediatric populations in low- and middle-income countries: a protocol for a systematic review. Syst Rev 2018; 7:52. [PMID: 29606128 PMCID: PMC5879941 DOI: 10.1186/s13643-018-0717-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/20/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) in pediatric populations is a major public health concern. It is associated with high rates of hospital admissions, disability, and mortality in high-income countries (HIC), but its burden is poorly documented in low- and middle-income countries (LMICs). We present a protocol for a systematic review and meta-analysis to summarize available data on the prevalence, incidence, etiologies, treatment, and outcomes including hospital admission and mortality and economic burden of HF in neonates, infants, children, and adolescents in LMICs. METHODS A comprehensive search of articles published between January 01, 2000, and December 31, 2017, will be performed in PubMed/MEDLINE, EMBASE, Global Index Medicus, and Web of Science. All cross-sectional, cohort studies and case-control studies reporting on the prevalence, incidence, etiologies, treatment, prognosis, admission rates, mortality, and economic burden of HF in pediatric populations in LMICs will be included in the review. The methodological quality of included studies will be appraised accordingly. For prognosis data, the Quality in Prognosis Studies (QUIPS) tool will be used. The symmetry of funnel plot and Egger's test will be used to identify publication bias. An overall summary estimate of prevalence/incidence of pediatric HF across studies will be obtained from study-specific estimates pooled through a random-effect model. Heterogeneity of studies will be assessed by the χ 2 test on Cochrane's Q statistic. A p value less than 0.05 will be considered significant for factors that predict mortality. This systematic review and meta-analysis will be reported following the PRISMA guidelines. DISCUSSION This study will report and summarize epidemiology data, as well as the economic burden of HF in neonates, infants, children, and adolescents of LMICs. Limitations will mainly arise from the heterogeneity in the diagnostic of HF. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017070189.
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Affiliation(s)
- Aurélie T. Sibetcheu
- Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
| | | | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Joël Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
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Jin X, Yin S, Zhang Y, Chen X. Association between TLR2 + 2477G/A polymorphism and bacterial meningitis: a meta-analysis. Epidemiol Infect 2018; 146:642-647. [PMID: 29457581 PMCID: PMC9134541 DOI: 10.1017/s0950268818000298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/27/2023] Open
Abstract
Toll-like receptor 2 (TLR2) is a key member of TLRs, which is crucial in the initial inflammatory response against bacteria. TLR2, is also the initial barrier against bacterial infection and plays an important role in recognising a variety of bacterial lipoproteins. Several studies have been performed to investigate the TLR2 + 2477G/A polymorphism and bacterial meningitis susceptibility. Unfortunately, the results of previous studies were controversial. Therefore, we performed a meta-analysis to derive a more precise estimation of the association. The association between the TLR2 + 2477G/A polymorphism and bacterial meningitis susceptibility was assessed by odds ratios together with their 95% confidence intervals (CI). Six studies were enrolled in the present meta-analysis. Overall, no significant association between TLR2 + 2477G/A polymorphism and bacterial meningitis risk were found under allele contrast (A vs. G: OR = 1.15, 95% CI = 0.93-1.43, P = 0.202), recessive genetic model (AA vs. AG/GG: OR = 1.12, 95% CI = 0.90-1.41, P = 0.313). The significant association was found between TLR2 + 2477G/A polymorphism and pneumococcal meningitis risk under allele contrast (A vs. G: OR = 1.54, 95% CI = 1.01-2.36, P = 0.046), recessive genetic model (AA vs. AG/GG: OR = 1.63, 95% CI = 1.03-2.57, P = 0.035). We conclude that TLR2 + 2477G/A polymorphism is not associated with meningococcal meningitis risk but contributes an increased risk of pneumococcal meningitis.
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Affiliation(s)
- Xiaochun Jin
- Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028, People's Republic of China
| | - Shuzhou Yin
- Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028, People's Republic of China
| | - Youtao Zhang
- Department of Clinical Laboratory, First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Xu Chen
- Department of Clinical Laboratory, First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
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Peng HL, Hu Y, Chen HJ, Song PP, Jiang L. Risk factors for poor prognosis in children with refractory purulent meningitis and the discharge criteria. J Infect Public Health 2018; 11:238-242. [DOI: 10.1016/j.jiph.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/14/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022] Open
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Contrôle cible de la température en réanimation (hors nouveau-nés). MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Al-Momen H, Muhammed MK, Alshaheen AA. Neonatal Seizures in Iraq: Cause and Outcome. TOHOKU J EXP MED 2018; 246:245-249. [DOI: 10.1620/tjem.246.245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hayder Al-Momen
- Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad
| | - Majed Kadhim Muhammed
- Department of Pediatrics, Al-Elwiyah Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Ministry of Health
| | - Ali Abdulhussein Alshaheen
- Department of Pediatrics, Al-Elwiyah Pediatric Teaching Hospital, Al-Rusafa Health Directorate, Ministry of Health
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Yang Y, Pan X, Cheng W, Yang Y, Scherpbier RW, Zhu X, Chen Y, Zhou Y, Jiang Q. Haemophilus influenzae type b carriage and burden of its related diseases in Chinese children: Systematic review and meta-analysis. Vaccine 2017; 35:6275-6282. [DOI: 10.1016/j.vaccine.2017.09.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 01/21/2023]
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47
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Targeted temperature management in the ICU: Guidelines from a French expert panel. Anaesth Crit Care Pain Med 2017; 37:481-491. [PMID: 28688998 DOI: 10.1016/j.accpm.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de réanimation de langue française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société francaise d'anesthésie réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société française de médecine d'urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe francophone de réanimation et urgences pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association nationale de neuro-anesthésie réanimation française [ANARLF]), and the French Neurovascular Society (Société française neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts' opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
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Abstract
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.
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Ranković A, Vrbić M, Jovanović M, Popović-Dragonjić L, Đorđević-Spasić M. MENINGEAL SYNDROME IN THE PRACTICE OF INFECTIOUS DISEASES SPECIALISTS. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Polkowska A, Toropainen M, Ollgren J, Lyytikäinen O, Nuorti JP. Bacterial meningitis in Finland, 1995-2014: a population-based observational study. BMJ Open 2017; 7:e015080. [PMID: 28592578 PMCID: PMC5734207 DOI: 10.1136/bmjopen-2016-015080] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Bacterial meningitis remains an important cause of morbidity and mortality worldwide. Its epidemiological characteristics, however, are changing due to new vaccines and secular trends. Conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae (10-valent) were introduced in 1986 and 2010 in Finland. We assessed the disease burden and long-term trends of five common causes of bacterial meningitis in a population-based observational study. METHODS A case was defined as isolation of S. pneumoniae, Neisseria meningitidis, Streptococcus agalactiae, Listeria monocytogenes or H. influenzae from cerebrospinal fluid and reported to national, population-based laboratory surveillance system during 1995-2014. We evaluated changes in incidence rates (Poisson or negative binomial regression), case fatality proportions (χ2) and age distribution of cases (Wilcoxon rank-sum). RESULTS During 1995-2014, S. pneumoniae and N. meningitidis accounted for 78% of the total 1361 reported bacterial meningitis cases. H. influenzae accounted for 4% of cases (92% of isolates were non-type b). During the study period, the overall rate of bacterial meningitis per 1 00 000 person-years decreased from 1.88 cases in 1995 to 0.70 cases in 2014 (4% annual decline (95% CI 3% to 5%). This was primarily due to a 9% annual reduction in rates of N. meningitidis (95% CI 7% to 10%) and 2% decrease in S. pneumoniae (95% CI 1% to 4%). The median age of cases increased from 31 years in 1995-2004 to 43 years in 2005-2014 (p=0.0004). Overall case fatality proportion (10%) did not change from 2004 to 2009 to 2010-2014. CONCLUSIONS Substantial decreases in bacterial meningitis were associated with infant conjugate vaccination against pneumococcal meningitis and secular trend in meningococcal meningitis in the absence of vaccination programme. Ongoing epidemiological surveillance is needed to identify trends, evaluate serotype distribution, assess vaccine impact and develop future vaccination strategies.
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Affiliation(s)
- Aleksandra Polkowska
- School of Health Sciences, University of Tampere, Lääkärinkatu, Tampere, Finland
| | - Maija Toropainen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - Jukka Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - J. Pekka Nuorti
- School of Health Sciences, University of Tampere, Lääkärinkatu, Tampere, Finland
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
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