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Liu Y, Feng Y, Guo Y, Chen J, Liu C, Liang J. Clinical predictors of poor outcome of bacterial meningitis in infants less than 90 days: a systematic review. Front Pediatr 2024; 12:1414778. [PMID: 39363966 PMCID: PMC11448124 DOI: 10.3389/fped.2024.1414778] [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: 04/09/2024] [Accepted: 08/22/2024] [Indexed: 10/05/2024] Open
Abstract
Background bacterial meningitis (BM) is more common in infants than at any other time in life and remains a devastating disease with considerable risk of death and morbidity. This article aims to gather the currently available evidence to perform a systematic review of clinical factors that may predict or be associated with BM death and/or sequelae in infants < 90 days of age. Methods The Medline/PubMed, Cochrane Library and Embase databases were systematically searched for prognostic studies that described risk factors for mortality and sequelae in infants aged <90d with BM. The databases were searched from the beginning of the database to December 31st, 2022.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). A systematic review was undertaken to ascertain the prognostic factors proven to be noteworthy. Results Of the 1,431 studies retrieved, 20 were eligible for the final analysis including 11 cohort and 9 cross-sectional studies were identified. Four risk factors predicting poor outcome were mentioned mostly in those studies, including prematurity or low birth weight (LBW), seizures, coma, and elevated CSF protein. But only preterm, coma and elevated CSF protein were identified by multivariate analyses in more than one study. Conclusions This study demonstrates several potential predictive factors to the poor outcomes of BM in infant. But with large heterogeneity, these predictors should be evaluated by further well-designed prospective studies. Systematic Review Registration https://www.crd.york.ac.uk/, identifier CRD42017074949.
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Affiliation(s)
- Ying Liu
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yu Feng
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - YanPing Guo
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - JingJing Chen
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chang Liu
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
| | - JiaBi Liang
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China
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van Ettekoven CN, Liechti FD, Brouwer MC, Bijlsma MW, van de Beek D. Global Case Fatality of Bacterial Meningitis During an 80-Year Period: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2424802. [PMID: 39093565 PMCID: PMC11297475 DOI: 10.1001/jamanetworkopen.2024.24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/16/2024] [Indexed: 08/04/2024] Open
Abstract
Importance The impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain. Objective To describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis. Data Sources Google Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality. Study Selection Included studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care-associated meningitis, tuberculous meningitis, or missing outcome were excluded. Data Extraction and Synthesis Data were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period's year as an estimator variable were used. Main Outcome and Measure Case fatality ratios of bacterial meningitis. Results This review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients' sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P < .001). Conclusions and Relevance In this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.
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Affiliation(s)
- Cornelis N. van Ettekoven
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, HagaZiekenhuis, The Hague, the Netherlands
| | - Fabian D. Liechti
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Merijn W. Bijlsma
- Department of Pediatrics, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Zhang L, Li W, Peng X, Jiang L, Hu Y. Clinical Features and a Prediction Nomogram for Prognosis in Children with Escherichia coli Meningitis. J Child Neurol 2023; 38:528-536. [PMID: 37574798 DOI: 10.1177/08830738231193217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND We aimed to build a prediction nomogram for early prediction of poor prognosis in children with Escherichia coli meningitis and analyzed the course of treatment and discharge criteria. METHODS Eighty-seven pediatric patients with E coli meningitis were retrospectively recruited from the Children's Hospital of Chongqing Medical University between June 2012 and November 2021. Univariate analysis and binary logistic analysis were used to evaluate the risk factors, and the prediction model was built. RESULTS E coli meningitis is more common in children <3 months old in our study (86.2%). Common complications were subdural effusion (39.1%), followed by hydrocephalus (13.8%) and repeated convulsions (12.6%). The mortality rate and sequelae rate of E coli meningitis in children was ∼10.9% and ∼6.3%, respectively. Univariate analysis showed that 13 clinical indicators were associated with poor prognosis of E coli meningitis in children. In binary logistic analysis, risk factors were seizures (P = .032) and the last cerebrospinal fluid glucose content before discharge (P = .002). A graphical nomogram was designed. The area under the receiver operating characteristic curve was 0.913. The Hosmer-Lemeshow test showed that the model was a good fit (P = .648). Internal validation proved the reliability of the prediction nomogram. CONCLUSIONS E coli meningitis is more common in children <3 months old in our study. The rate of complications and sequelae are high. The prediction nomogram could be used to assess the risk of poor prognosis in children with E coli meningitis by clinicians.
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Affiliation(s)
- Lingyu Zhang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health 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
| | - Wenjie Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health 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
| | - Xiaoling Peng
- Guangdong Provincial Key Laboratory of Interdisciplinary Research and Application for Data Science, BNU-HKBU United International College, Zhuhai, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health 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
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health 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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Bizubac M, Balaci-Miroiu F, Filip C, Vasile CM, Herișeanu C, Marcu V, Stoica S, Cîrstoveanu C. Neonatal Brain Abscess with Serratia marcescens after Intrauterine Infection: A Case Report. Antibiotics (Basel) 2023; 12:antibiotics12040722. [PMID: 37107084 PMCID: PMC10135221 DOI: 10.3390/antibiotics12040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Brain abscesses are a possible complication of bacterial sepsis or central nervous system infection but are uncommon in the neonatal period. Gram-negative organisms often cause them, but Serratia marcescens is an unusual cause of sepsis and meningitis in this age group. This pathogen is opportunistic and frequently responsible for nosocomial infections. Despite the existing antibiotics and modern radiological tools, mortality and morbidity remain significant in this group of patients. We report an unusual unilocular brain abscess in a preterm neonate caused by Serratia marcescens. The infection had an intrauterine onset. The pregnancy was achieved through assisted human reproduction techniques. It was a high-risk pregnancy, with pregnancy-induced hypertension, imminent abortion, and required prolonged hospitalization of the pregnant woman with multiple vaginal examinations. The infant was treated with multiple antibiotic cures and percutaneous drainage of the brain abscess associated with local antibiotic treatment. Despite treatment, evolution was unfavorable, complicated by fungal sepsis (Candida parapsilosis) and multiple organ dysfunction syndrome.
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Affiliation(s)
- Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Francisca Balaci-Miroiu
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Carmen Herișeanu
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Veronica Marcu
- Department of Radiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Sergiu Stoica
- Department of Neurosurgery, Monza Hospital, 021967 Bucharest, Romania
| | - Catalin Cîrstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
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Pons S, Frapy E, Sereme Y, Gaultier C, Lebreton F, Kropec A, Danilchanka O, Schlemmer L, Schrimpf C, Allain M, Angoulvant F, Lecuyer H, Bonacorsi S, Aschard H, Sokol H, Cywes-Bentley C, Mekalanos JJ, Guillard T, Pier GB, Roux D, Skurnik D. A high-throughput sequencing approach identifies immunotherapeutic targets for bacterial meningitis in neonates. EBioMedicine 2023; 88:104439. [PMID: 36709579 PMCID: PMC9900374 DOI: 10.1016/j.ebiom.2023.104439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Worldwide, Escherichia coli is the leading cause of neonatal Gram-negative bacterial meningitis, but full understanding of the pathogenesis of this disease is not yet achieved. Moreover, to date, no vaccine is available against bacterial neonatal meningitis. METHODS Here, we used Transposon Sequencing of saturated banks of mutants (TnSeq) to evaluate E. coli K1 genetic fitness in murine neonatal meningitis. We identified E. coli K1 genes encoding for factors important for systemic dissemination and brain infection, and focused on products with a likely outer-membrane or extra-cellular localization, as these are potential vaccine candidates. We used in vitro and in vivo models to study the efficacy of active and passive immunization. RESULTS We selected for further study the conserved surface polysaccharide Poly-β-(1-6)-N-Acetyl Glucosamine (PNAG), as a strong candidate for vaccine development. We found that PNAG was a virulence factor in our animal model. We showed that both passive and active immunization successfully prevented and/or treated meningitis caused by E. coli K1 in neonatal mice. We found an excellent opsonophagocytic killing activity of the antibodies to PNAG and in vitro these antibodies were also able to decrease binding, invasion and crossing of E. coli K1 through two blood brain barrier cell lines. Finally, to reinforce the potential of PNAG as a vaccine candidate in bacterial neonatal meningitis, we demonstrated that Group B Streptococcus, the main cause of neonatal meningitis in developed countries, also produced PNAG and that antibodies to PNAG could protect in vitro and in vivo against this major neonatal pathogen. INTERPRETATION Altogether, these results indicate the utility of a high-throughput DNA sequencing method to identify potential immunotherapy targets for a pathogen, including in this study a potential broad-spectrum target for prevention of neonatal bacterial infections. FUNDINGS ANR Seq-N-Vaq, Charles Hood Foundation, Hearst Foundation, and Groupe Pasteur Mutualité.
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Affiliation(s)
- Stéphanie Pons
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière, Paris, France
| | - Eric Frapy
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France; Faculté de Médecine, University of Paris City, Paris, France
| | - Youssouf Sereme
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France; Faculté de Médecine, University of Paris City, Paris, France
| | - Charlotte Gaultier
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - François Lebreton
- Department of Ophthalmology and Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02114, USA
| | - Andrea Kropec
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Olga Danilchanka
- Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Laura Schlemmer
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France
| | - Cécile Schrimpf
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France
| | - Margaux Allain
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France
| | - François Angoulvant
- Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Necker-Enfants Malades University Hospital, University of Paris City, Paris, France; INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France
| | - Hervé Lecuyer
- CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France; Faculté de Médecine, University of Paris City, Paris, France; Department of Clinical Microbiology, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Necker-Enfants Malades University Hospital, University of Paris City, Paris, France
| | - Stéphane Bonacorsi
- E IAME, UMR 1137, INSERM, Université de Paris, AP-HP, Paris, France; Laboratoire de Microbiologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - Hugues Aschard
- Centre de Bioinformatique, Biostatistique et Biologie Intégrative (C3BI), Institut Pasteur, Paris, France; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Harry Sokol
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, F-75012 Paris, France; INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France; Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Colette Cywes-Bentley
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - John J Mekalanos
- Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas Guillard
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Université de Reims Champagne-Ardenne, SFR CAP-Santé, Inserm UMR-S 1250 P3Cell, Reims, France; Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière-Parasitologie-Mycologie, CHU, Reims, France
| | - Gerald B Pier
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Damien Roux
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Université de Paris, INSERM, UMR 1137 IAME, F-75018 Paris, France; AP-HP, Médecine Intensive Réanimation, Hôpital Louis Mourier, F-92700 Colombes, France
| | - David Skurnik
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; CNRS, INSERM, Institut Necker Enfants Malades-INEM, F-75015 Paris, France; Faculté de Médecine, University of Paris City, Paris, France; Department of Clinical Microbiology, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Necker-Enfants Malades University Hospital, University of Paris City, Paris, France.
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Zou P, Yang F, Ding Y, Zhang D, Liu Y, Zhang J, Wu D, Wang Y. Lipopolysaccharide downregulates the expression of ZO-1 protein through the Akt pathway. BMC Infect Dis 2022; 22:774. [PMID: 36199030 PMCID: PMC9533599 DOI: 10.1186/s12879-022-07752-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Neonatal bacterial meningitis is a common neonatal disease with high morbidity, and can cause serious sequelae when left untreated. Escherichia coli is the common pathogen, and its endotoxin, lipopolysaccharide (LPS) can damage the endothelial cells, increasing the permeability of the blood-brain barrier (BBB), leading to intracranial inflammation. However, the specific mechanism of bacterial meningitis induced by LPS damaging BBB remains unclear. In this study, the mouse brain microvascular endothelial (bEND.3) cells were used as a research object to investigate whether LPS damage BBB through the PI3K/Akt pathway. Methods The bEND.3 cells were stimulated with different concentrations of LPS for 12 h, and the expression of tight junction proteins (ZO-1, claudin-5, occludin) was detected using western blotting. The cells were challenged with the same concentration of LPS (1ug/ml) across different timepoints (0, 2 h, 4 h, 6 h, 12 h, 24 h). Expression of TJ proteins and signal pathway molecules (PI3K, p-PI3K, Akt, p-Akt) were detected. The distribution of ZO-1 in bEND.3 cells were detected by immunofluorescence staining. Results A negative correlation is observed between ZO-1 and LPS concentration. Moreover, a reduced expression of ZO-1 was most significant under 1 ug/ml of LPS, and the difference was statistically significant (P < 0.05). Additionally, there is a negative correlation between ZO-1 and LPS stimulation time. Meanwhile, the expression of claudin-5 and occludin did not change significantly with the stimulation of LPS concentration and time. The immunofluorescence assay showed that the amount of ZO-1 on the surface of bEND.3 cells stimulated with LPS was significantly lower than that of the control group. After LPS stimulation, p-Akt protein increased at 2 h and peaked at 4 h. The titer of p-PI3K did not change significantly with time. Conclusion LPS can downregulate the expression of ZO-1; however, its effect on claudin-5 and occludin is minimal. Akt signal pathway may be involved in the regulation of ZO-1 expression induced by LPS in bEND.3 cells. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07752-1.
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Affiliation(s)
- Peicen Zou
- Capital Institute of Pediatrics, Beijing, China
| | - Fan Yang
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yijun Ding
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Di Zhang
- Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Ying Liu
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinjing Zhang
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Dan Wu
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yajuan Wang
- Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
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Xiao H, Xiao H, Zhang Y, Guo L, Dou Z, Liu L, Zhu L, Feng W, Liu B, Hu B, Chen T, Liu G, Wen T. High-throughput sequencing unravels the cell heterogeneity of cerebrospinal fluid in the bacterial meningitis of children. Front Immunol 2022; 13:872832. [PMID: 36119025 PMCID: PMC9478118 DOI: 10.3389/fimmu.2022.872832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Bacterial meningitis (BM) is a common life-threatening infection in children that occurs in the central nervous system (CNS). The cytologic examination of cerebrospinal fluid (CSF) is a key parameter in the diagnosis of BM, but the heterogeneity of cells in the CSF has not been elucidated, which limits the current understanding of BM neuroinflammation. In this study, CSF samples were collected from a number of BM patients who were in different stages of disease progression. Single-cell RNA-sequencing (scRNA-seq), with additional bulk transcriptome sequencing, was conducted to decipher the characteristics of CSF cells in BM progression. A total of 18 immune cell clusters in CSF were identified, including two neutrophils, two monocytes, one macrophage, four myeloid dendritic cells, five T cells, one natural killer cell, one B cell, one plasmacytoid dendritic cell, and one plasma cell subtype. Their population profiles and dynamics in the initial onset, remission, and recovery stages during BM progression were also characterized, which showed decreased proportions of myeloid cells and increased proportions of lymphoid cells with disease progression. One novel neutrophil subtype, FFAR2+TNFAIP6+ neutrophils, and one novel monocyte subtype, THBS1+IL1B+ monocytes, were discovered, and their quantity changes positively correlated with the intensity of the inflammatory response in the CSF during BM. In addition, the CSF of BM patients with unsatisfactory therapeutic responses presented with different cell heterogeneity compared to the CSF of BM patients with satisfactory therapeutic responses, and their CSF featured altered intercellular communications and increased proportions of type II myeloid dendritic cells and plasmacytoid dendritic cells. Moreover, the bulk transcriptome profiles of autologous CSF cells and peripheral blood leukocytes of BM patients showed that the immune cells in these two physiological compartments exhibited distinct immune responses under different onset conditions. In particular, the CSF cells showed a high expression of macrophage characteristic genes and a low expression of platelet characteristic genes compared with peripheral blood leukocytes. Our study conducted an in-depth exploration of the characteristics of CSF cells in BM progression, which provided novel insights into immune cell engagement in acute CNS infection.
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Affiliation(s)
- Haihan Xiao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Haijuan Xiao
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yun Zhang
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lingyun Guo
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhenzhen Dou
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Linlin Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Liang Zhu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wenya Feng
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Bing Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Bing Hu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tianming Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- *Correspondence: Tingyi Wen, ; Gang Liu,
| | - Tingyi Wen
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Tingyi Wen, ; Gang Liu,
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Li YT, Li CX, Huang CJ, Wen QY, Deng SM, Zhu LP, Liu ZF, Chen ZG. Meconium-Stained Amniotic Fluid: Impact on Prognosis of Neonatal Bacterial Meningitis. J Trop Pediatr 2022; 68:6665809. [PMID: 35962981 DOI: 10.1093/tropej/fmac064] [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: 11/13/2022]
Abstract
OBJECTIVES Clinical data with respect to the impact of meconium on the prognosis of neonatal bacterial meningitis are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for poor prognosis of neonatal bacterial meningitis in a confirmed case population. METHODS This was a retrospective cohort study of 256 neonates diagnosed with bacterial meningitis hospitalized at one of three hospitals in Shantou, China, between October 2013 and September 2018. Clinical manifestation, laboratory test results and treatment were compared between the two groups, with outcomes dichotomized into 'good' or 'poor' prognosis. Multivariate analysis and follow-up logistic regression analysis were used to identify predictive factors of a poor outcome. RESULTS Of the 256 neonates with BM, 95 (37.1%) had a good prognosis at discharge and 161 (62.9%) had a poor prognosis. In the poor prognosis group, 131/161 (79.4%) neonates had a permanent neurological sequelae and 19 (11.8%) had ≥2 sequelae. Of note, 11 neonates died. The rate of poor prognosis of BM was significantly higher among neonates with than without MSAF (26.1% vs. 12.6%, respectively; p < 0.05). A logistic multivariate analysis to evaluate the prognostic effect of MSAF to BM showed that neonatal with MSAF is more likely to have a worse prognosis of BM [unadjusted odds ratio (OR), 2.44, 95% confidence interval (CI), 1.24-5.10; adjusted OR, 2.31; 95% CI, 1.09-5.17]. CONCLUSION MSAF is significantly associated with poor prognosis of neonatal bacterial meningitis. Therefore, in case of MSAF, more attention should be paid to neonatal bacterial meningitis.
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Affiliation(s)
- Ya-Ting Li
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Cai-Xia Li
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chu-Jun Huang
- Department of Pediatrics, Shantou Central Hospital, Shantou, China
| | - Qian-Yu Wen
- Clinical Data Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shu-Min Deng
- Department of Pediatrics, Shantou Central Hospital, Shantou, China
| | - Ling-Ping Zhu
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zi-Feng Liu
- Clinical Data Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhuang-Gui Chen
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Oumer M, Abebaw D, Tazebew A. Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021. PLoS One 2022; 17:e0271997. [PMID: 35900981 PMCID: PMC9374017 DOI: 10.1371/journal.pone.0271997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal sepsis is a leading cause of neonatal morbidity and mortality,
particularly in developing countries. Time to recovery is an indicator of
the severity of sepsis, and risk factors varied significantly according to
study population and settings. Moreover, published literature regarding the
time to recovery of neonatal sepsis is scarce. Objective The aim of this study was to assess the time to recovery of neonatal sepsis
and determinant factors among neonates admitted in the Public Hospitals of
Central Gondar Zone, Northwest Ethiopia. Methods An institution-based prospective follow-up study design was conducted among
631 neonates with sepsis. A structured, pre-tested, interviewer-administered
questionnaire was used. The median time to recovery, life-table, the Kaplan
Meier curve, and the log-rank test were computed. Both bi-variable and
multivariable Cox regression models were applied to analyze the data. Results Of all septic neonates, 511 successfully recovered. They were followed for a
total of 4,740-neonate day’s observation and the median time to recovery was
7 days (IQR = 5–10 days). After adjusting for covariates, intrapartum fever
(AHR = 0.69, 95%CI: 0.49, 0.99), induced onset of labor (AHR = 0.68, 95%CI:
0.49, 0.94), chest indrawing (AHR = 0.67, 95%CI: 0.46, 0.99), late onset
sepsis (AHR = 0.55, 95%CI: 0.40, 0.75), non-oral enteral feeding (AHR =
0.38, 95%CI: 0.29, 0.50), assisted with bag and mask (AHR = 0.72, 95%CI:
0.56, 0.93), normal birth weight (AHR = 1.42, 95%CI: 1.03, 1.94),
gestational age of 37–42 weeks (AHR = 1.93, 95%CI: 1.32, 2.84), septic shock
(AHR = 0.08, 95%CI: 0.02, 0.39), infectious complications (AHR = 0.42,
95%CI: 0.29, 0.61), being in critical conditions (AHR = 0.68, 95%CI: 0.52,
0.89), and early recognition of illness (AHR = 1.83, 95%CI: 1.27, 2.63) were
independently associated with the time to recovery of neonatal sepsis. Conclusions and recommendations The time to recovery of this study was moderately acceptable as compared to
the previous studies. The above-mentioned factors could be used for the
early identification of neonates with sepsis at risk for protracted illness
and it could guide prompt referral to higher centers in primary health
sectors. This also will provide prognostic information to clinicians and
families as longer recovery time has economic and social implications in our
country.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Dessie Abebaw
- Department of Epidemiology and Biostatistics, Institute of Public Health,
College of Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
| | - Ashenafi Tazebew
- Department of Pediatrics and Child Health, School of Medicine, College of
Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
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Cheng X, Zhang Q, Fu Z, Shi Z, Xia P, Zhang Y, Mao F, Xu Q, Yan X, Wang L. Establishment of a predictive model for purulent meningitis in preterm infants. Transl Pediatr 2022; 11:1018-1027. [PMID: 35800267 PMCID: PMC9253939 DOI: 10.21037/tp-22-236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Purulent meningitis (PM) is an important cause of mortality and morbidity in the newborn population throughout the world. The subtle of specific clinical signs and low success rates of lumbar puncture make diagnosis of PM more difficult in preterm than in older children. The objective of this study was to establish a predict model for preterm PM in hopes of helping clinicians develop new diagnostic and treatment strategies. METHODS Premature infants who were admitted to The First Affiliated Hospital of Zhengzhou University from September 2017 to March 2020 were enrolled in this study. All the patients underwent lumbar puncture. We collected data encompassing maternal diseases and neonatal clinical features. Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing meningitis. The PM was diagnosed according to the diagnostic criteria. All statistical analyses were performed using R 3.63 (https://www.r-project.org/). Logistic regression and least absolute shrinkage and selection operator (LASSO) regression analyses were used to establish a risk prediction model of PM. The Brier score, calibration slope, and concordance (C)-index were used to verify the accuracy of prediction model. RESULTS A total of 168 preterm infants were enrolled in this study, 80 boys and 88 girls, the gestational age (GA) was 26.43-36.86 weeks (32.45±2.79 weeks), the birth weight (BW) was 700-3,400 g (1,814.05±568.84 g). There were 77 preterm infants with PM while 91 without. We identified seven variables as independent risk factors for PM in preterm infants by LASSO analysis [the optimal λ was 0.080960, and log(λ) = -2.5138], including procalcitonin (PCT) on the 1st day after birth, prenatal glucocorticoid use, albumin, the 1-minute Apgar score, the use of non-invasive biphasic positive airway pressure, hemoglobin, and sex. These were used to construct a risk prediction nomogram and verified its accuracy. The Brier score was 0.17, the calibration slope was 0.966, and the concordance index was 0.82018. CONCLUSIONS Our prediction model could predict the risk of PM in preterm infants. Using this prediction model, it may be able to provide reference to determine whether lumbar puncture is performed and whether antibiotics are applied as soon as possible.
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Affiliation(s)
- Xinru Cheng
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Treatment and Follow-Up Center for High-Risk Newborns of Henan Province, Zhengzhou, China.,Zhengzhou Key Laboratory for the Prevention and Control of Developmental Disorders, Zhengzhou, China
| | - Qian Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Treatment and Follow-Up Center for High-Risk Newborns of Henan Province, Zhengzhou, China.,Zhengzhou Key Laboratory for the Prevention and Control of Developmental Disorders, Zhengzhou, China
| | - Zhaoqin Fu
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Treatment and Follow-Up Center for High-Risk Newborns of Henan Province, Zhengzhou, China
| | - Zanyang Shi
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Treatment and Follow-Up Center for High-Risk Newborns of Henan Province, Zhengzhou, China.,Zhengzhou Key Laboratory for the Prevention and Control of Developmental Disorders, Zhengzhou, China
| | - Peige Xia
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Clinical Treatment and Follow-Up Center for High-Risk Newborns of Henan Province, Zhengzhou, China
| | - Yanan Zhang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengxia Mao
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianya Xu
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaomin Yan
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Neonatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang H, Zhu X. Cerebrospinal fluid culture-positive bacterial meningitis increases the risk for neurologic damage among neonates. Ann Med 2021; 53:2199-2204. [PMID: 34787529 PMCID: PMC8604535 DOI: 10.1080/07853890.2021.2004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/03/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE This study aimed to compare the clinical features and outcomes of neonatal bacterial meningitis (NBM) between patients with positive and negative cerebrospinal fluid (CSF) cultures and determine the risk factors for CSF culture-positive NBM. METHODS We retrospectively reviewed the medical records of all patients with NBM. Perinatal clinical data, laboratory results, and cranial radiographs were obtained. RESULTS Among the 186 neonates who met the inclusion criteria. The risk factors for positive CSF culture results were analysed using multiple logistic regression. The multivariable logistic regression analysis showed that the possible risk factors of NBM with positive CSF culture in this study were: Length of fever [OR = 1.126; 95% CI (0.999-1.268)], Neurologic symptoms [OR = 3.043; 95% CI (1.164-7.959)], Cerebrospinal fluid protein [OR = 1.001; 95% CI (1.000-1.001)]. Cases of NBM with a longer duration of fever, more neurologic symptoms, and higher levels of CSF protein were more likely to demonstrate positive results on CSF culture. CONCLUSION Cases of NBM with CSF culture-positive results were more likely to have severe clinical manifestations and develop more serious neurologic damage. Patients with NBM who have longer durations of fever, more neurologic symptoms, and higher levels of CSF protein were more likely to have CSF culture-positive results, who should be followed up more closely.Key MessageBacterial meningitis is clinically defined as a serious inflammation of meningitis, usually caused by a variety of bacterial infections that may leave sequelae and long-term complications and high mortality rates. Early diagnosis is often difficult, particularly when the patient has been treated with antimicrobials.
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Affiliation(s)
- Huawei Wang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou City, Jiangsu Province, China
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Predictor of a permanent shunt after treatment of external ventricular draining in pediatric postinfective hydrocephalus-a retrospective cohort study. Childs Nerv Syst 2021; 37:1877-1882. [PMID: 33483758 DOI: 10.1007/s00381-021-05054-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the therapeutic efficacy of external ventricular draining (EVD) and to predict the need for permanent shunts in infants with postinfective hydrocephalus (PIHC). METHODS This is a retrospective study of infants diagnosed with PIHC and treated by EVD between January 2013 and December 2017 at the Children's Hospital of Fudan University. Clinical, laboratory, and imaging data were collected and analyzed to identify independent risk factors by logistic regression analyses. The predictor was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. RESULTS In total, 48 patients were identified, and 31 cases (64.5%) had a permanent shunt. EVD was effective in accelerating cerebrospinal fluid purification. In the permanent shunt group, the duration of EVD was significantly longer (28.5 ± 5.2 vs 14.9 ± 3.0 P < 0.05) and the frontal and occipital horn ratio (FOHR) at 7-10 days after EVD was significantly higher (0.57 ± 0.01 vs 0.48 ± 0.01 P < 0.001). The FOHR at 7-10 days after EVD predicts the need for a permanent shunt with an area under the ROC curve of 0.818. CONCLUSION EVD was effective for purification of CSF, whereas a permanent shunt was needed for more than half of the patients. The FOHR at 7-10 days after EVD may be a strong predictor for a permanent shunt.
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Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: a review of the literature and description of three cases. BMC Infect Dis 2021; 21:15. [PMID: 33407192 PMCID: PMC7788956 DOI: 10.1186/s12879-020-05702-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Klebsiella pneumoniae (K. pneumoniae) invasive liver abscess syndrome (ILAS) with purulent meningitis was rarely identified the mainland of China. Last winter, we received 3 cases of K. pneumoniae meningitis and all of them died in a short time. We report these cases in order to find the reason of high mortality and discuss effective effort to improve these patients’ prognosis. Case presentation Three patients with uncontrolled diabetes developed live abscess and purulent meningitis. Upon admission, the clinical manifestations, laboratory result of blood and cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae ILAS which had metastasis infection of meningitis. Even with timely adequate antibiotic therapy and strict glycemic control, all of the patients’ condition deteriorated rapidly and died in a short time. Conclusion The reason of patients’ poor prognosis might be the absence of liver abscess drainage, high level of CSF protein which indicates severe inflammation and unknown special but stronger virulence factors of K. pneumoniae the patients’ living place Zhangjiakou. Strict glycemic control, early drainage of liver abscess and appropriate antibiotic application are recommended for treating this condition, further progress on the pathogenesis and treatment of K. pneumoniae meningitis may help patients gain a better prognosis.
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14
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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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Liu G, He S, Zhu X, Li Z. Early onset neonatal bacterial meningitis in term infants: the clinical features, perinatal conditions, and in-hospital outcomes: A single center retrospective analysis. Medicine (Baltimore) 2020; 99:e22748. [PMID: 33080738 PMCID: PMC7571871 DOI: 10.1097/md.0000000000022748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.
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Affiliation(s)
- Gang Liu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou
| | - Shan He
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou
| | - Zhenguang Li
- Department of Neonatology, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, China
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Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age. PLoS One 2020; 15:e0238056. [PMID: 32857801 PMCID: PMC7454955 DOI: 10.1371/journal.pone.0238056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/08/2020] [Indexed: 11/27/2022] Open
Abstract
Background There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis. Objective To evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort. Methods This cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians. Results Forty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%. Conclusion In this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.
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Boskabadi H, Heidari E, Zakerihamidi M. Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis. IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:89-97. [PMID: 32494342 PMCID: PMC7244827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal meningitis is one of the most important and serious neonatal infections with a high mortality and morbidity rate. The present study aimed to investigate the causes, clinical signs, laboratory parameters and mortality rates in newborns with bacterial meningitis. MATERIALS AND METHODS This cross-sectional study was performed on 468 neonates aged 2-28 days admitted to NICU in Ghaem Hospital Mashhad, Iran by available sampling method during 2009-2018. Meningitis was confirmed according to positive results of CSF culture and clinical feature. By using researcher-made questionnaire, neonate's individual data including cardiopulmonary resuscitation, the Apgar score of the first and fifth minutes, gestational age, birth weight, clinical symptoms and laboratory data such as ESR, WBC and positive culture of CSF were studied. RESULTS Among 468 newborn suspected to infection, lumbar Puncture (LP) was performed for 233 cases (50%). Of 233 neonates, 148 neonates (63.5%) had negative results for CSF culture and 85 cases (36.5%) had positive CSF culture. 94% of cases with meningitis were born premature. Blood culture had positive results in 80% of infants with late-onset meningitis and negative in 20%. The most common clinical findings were respiratory symptoms (94%). Klebsiella pneumoniae and Entrobacter aerugenes were the most common microorganisms of meningitis. Gestational disorders were observed in 55.3% of newborns with meningitis. C-Reactive Protein (CRP) of neonates with meningitis was twice higher than normal cases, and leukocytes and proteins in the CSF in neonates with meningitis were higher than healthy ones. Finally, 36% of neonates with meningitis died in our study. For analyzing the relationships between variables, independent t-test was used after controlling the normality, and Chi-square was used for analyzing the relationship of variables with nominal scale. CONCLUSION The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respiratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leukocytes and proteins in CSF.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Heidari
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
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Pormohammad A, Lashkarbolouki S, Azimi T, Gholizadeh P, Bostanghadiri N, Safari H, Armin S, Mohtavinejad N, Fallah F. Clinical characteristics and molecular epidemiology of children with meningitis in Tehran, Iran: a prospective study. New Microbes New Infect 2019; 32:100594. [PMID: 31641511 PMCID: PMC6796727 DOI: 10.1016/j.nmni.2019.100594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023] Open
Abstract
The molecular epidemiology of meningitis in children is unclear in Iran, and data are scarce. We aimed to characterize its clinical and paraclinical features as well as to determine the distribution of genotype/capsular types of common bacterial meningitis agents in children in Iran. All children suspected to have meningitis aged 4 days to 15 years were enrolled onto a prospective cross-sectional study from January 2015 to September 2017. Diagnostic values of clinical features, cerebrospinal fluid and serum parameters were evaluated independently and in combination with each other by multivariate logistic regression to develop a diagnostic rule. Genotype/capsular types of all the isolates were determined by targeting serotype-specific genes with uniplex or multiplex PCR. Among 119 patients suspected of having meningitis, 43 had bacterial meningitis, 19 aseptic and one tuberculous; and there were 56 nonmeningitis cases (NMC). Presentation of four features at the same time-cerebrospinal fluid white blood cell count, protein, polymorphonuclear leukocytes and serum C-reactive protein-revealed 100% sensitivity and 86.4% specificity for diagnosis of bacterial meningitis. Haemophilus influenzae type b (60%), Streptococcus pneumoniae serotype 3 (28.5%) and Neisseria meningitidis B (63.5%) were the most prevalent serotypes. This study demonstrated that a well-designed combination of clinical and paraclinical features is useful, but these combinations are not good enough to be relied on as stand-alone exclusionary tests for the diagnosis of bacterial meningitis. In addition, public immunization of infants with the most prevalent bacterial meningitis serotypes is recommended.
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Affiliation(s)
- A. Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S. Lashkarbolouki
- Department of Biology, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - T. Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - P. Gholizadeh
- Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - N. Bostanghadiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H. Safari
- Health Promotion Research Center, school of public health, Iran University of Medical Sciences, Tehran, Iran
| | - S. Armin
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N. Mohtavinejad
- Department of Radio Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - F. Fallah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Liu MD, Xu FL, Duan WL, Liu JX, Li XN, Liu YX, Wang YJ. [Risk factors for poor prognosis of neonatal bacterial meningitis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:1064-1068. [PMID: 31753085 PMCID: PMC7389301 DOI: 10.7499/j.issn.1008-8830.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the risk factors for poor prognosis of neonatal bacterial meningitis. METHODS A retrospective analysis was performed for the clinical data of 152 children with neonatal bacterial meningitis. According to their prognosis, they were divided into a good prognosis group with 122 children and a poor prognosis group with 30 children. The two groups were compared in terms of general status, initial symptoms, and laboratory findings, and the risk factors for poor prognosis were analyzed. RESULTS Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of children with a very low birth weight, a peripheral blood white blood cell count (WBC) of <5×109/L or >20×109/L, a C-reactive protein level of >50 mg/L, a cerebrospinal fluid (CSF) WBC of >500×106/L, a CSF glucose level of <1 mmol/L, or a CSF protein level of >2 g/L, as well as significantly higher positive rates of blood culture and/or CSF culture, Gram-positive bacteria, and Streptococcus agalactiae (P<0.05). The multivariate logistic regression analysis showed that a CSF glucose level of <1 mmol/L and a CSF protein level of >2 g/L were independent risk factors for poor prognosis of neonatal bacterial meningitis. CONCLUSIONS A CSF glucose level of <1 mmol/L and a CSF protein level of >2 g/L are risk factors for poor prognosis of neonatal bacterial meningitis.
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Affiliation(s)
- Meng-Di Liu
- Department of Neonatology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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20
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[A clinical analysis of bacterial meningitis in full-term and preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019. [PMID: 31642442 PMCID: PMC7389722 DOI: 10.7499/j.issn.1008-8830.2019.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To study the clinical features and prognosis of bacterial meningitis in full-term and preterm infants. METHODS A retrospective analysis was performed for the clinical data of 102 neonates with bacterial meningitis. According to the gestational age, they were divided into a preterm group (n=46) and a full-term group (n=56). The two groups were compared in terms of clinical manifestations, laboratory markers, imaging findings, and clinical outcomes. RESULTS Poor response and apnea were the major clinical manifestations in the preterm group (P<0.05), while pyrexia and convulsions were more common in the full-term group (P<0.05). The full-term group had a significantly higher glucose level in cerebrospinal fluid (CSF) than the preterm group (P<0.05). Compared with the full-term group, the preterm group had significantly higher C-reactive protein level, positive rate of blood culture, and incidence rate of poor prognosis (P<0.05). There were no significant differences between the two groups in leukocyte count in peripheral blood, levels of leukocytes and protein in CSF, and positive rate of CSF culture (P>0.05). CONCLUSIONS There are certain differences in the clinical manifestations between full-term and preterm infants with bacterial meningitis. Preterm infants tend to have a higher incidence rate of poor prognosis.
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Xu M, Hu L, Huang H, Wang L, Tan J, Zhang Y, Chen C, Zhang X, Huang L. Etiology and Clinical Features of Full-Term Neonatal Bacterial Meningitis: A Multicenter Retrospective Cohort Study. Front Pediatr 2019; 7:31. [PMID: 30815433 PMCID: PMC6381005 DOI: 10.3389/fped.2019.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/24/2019] [Indexed: 01/30/2023] Open
Abstract
Objective: Neonatal bacterial meningitis is a severe infectious disease with a high risk of neurodevelopmental sequelae. The causative pathogens may be related to specific clinical features of the disease. Therefore, this study aimed at determining the pathogen-specific and clinical features of bacterial meningitis in full-term neonates. Methods: We enrolled neonates from the Shanghai Neonate Meningitis Cohort (2005-2017), which is a multicenter retrospective cohort that recruits almost all full-term neonates in Shanghai who underwent lumbar puncture. Patient history and clinical examination results were extracted from the computer-documented information systems of four hospitals. The trends of pathogen distribution were analyzed and differences in the clinical manifestations, treatment, and clinical outcomes at discharge were compared according to the causative pathogen. Logistic regression was used to evaluate the pathogen-specific risk of neurological complications. Results: In total, 518 cases of neonatal meningitis, including 189 proven cases, were included. Group B Streptococcus (GBS) and Escherichia coli (E. coli) were the leading pathogens in proven cases of early-onset and late-onset neonatal meningitis, respectively. The proportion of early-onset and late-onset GBS and late-onset E. coli meningitis cases increased gradually. GBS meningitis had the highest risk of neurological complications, whereas the overall incidence of hydrocephalus and brain abscess in E. coli was higher than that in GBS. Conclusions: Rates of neonatal GBS and E. coli meningitis were high in 2005-2017 in Shanghai, and the risk of neurological complications was also high. Therefore, active prevention, rational use of antibiotics, and continuous monitoring of GBS and E. coli in neonates should be initiated in Shanghai.
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Affiliation(s)
- Min Xu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lan Hu
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, China
| | - Heyu Huang
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liping Wang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jintong Tan
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongjun Zhang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children Hospital of Fudan University, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lisu Huang
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 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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Hsu MH, Hsu JF, Kuo HC, Lai MY, Chiang MC, Lin YJ, Huang HR, Chu SM, Tsai MH. Neurological Complications in Young Infants With Acute Bacterial Meningitis. Front Neurol 2018; 9:903. [PMID: 30405525 PMCID: PMC6207629 DOI: 10.3389/fneur.2018.00903] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 01/27/2023] Open
Abstract
We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes. Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.
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Affiliation(s)
- Mei-Hsin Hsu
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan-Chang Kuo
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Meiho University, Ping Tung, Taiwan
| | - Mei-Yin Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ying-Jui Lin
- Division of Neurology and Pediatric Critical Care, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan
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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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25
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Zhao Z, Yu JL, Zhang HB, Li JH, Li ZK. Five-Year Multicenter Study of Clinical Tests of Neonatal Purulent Meningitis. Clin Pediatr (Phila) 2018; 57:389-397. [PMID: 28868893 DOI: 10.1177/0009922817728699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to provide more data support for early diagnosis and treatment of neonatal purulent meningitis through retrospective analysis of its clinical diagnosis and treatment, pathogen distribution, and drug resistance in 5 third-class A hospitals in Southwest and Northwest China from January 2011 to December 2015. It was found that both the positive rates of blood and cerebrospinal fluid culture were low, and Escherichia coli should be the main pathogenic bacteria. Drug-resistant strains with varying degrees to the third generation of cephalosporin antibiotics have appeared currently.
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Affiliation(s)
- Zhi Zhao
- 1 Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Shanxi Province People's Hospital, Xi'an, Shaanxi Province, China
| | - Jia-Lin Yu
- 1 Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hai-Bo Zhang
- 3 Children's Hospital of Xi'an, Xi'an, Shaanxi Province, China
| | - Ju-Hua Li
- 4 Children's Hospital of Xianyang, Xianyang, Shaanxi Province, China
| | - Zhan-Kui Li
- 5 Northwest Women and Children's Hospital, Xi'an, Shaanxi Province, China
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26
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Noureldein M, Mardare R, Pickard J, Shing HL, Eisenhut M. Cerebrospinal fluid protein and glucose levels in neonates with a systemic inflammatory response without meningitis. Fluids Barriers CNS 2018. [PMID: 29540199 PMCID: PMC5853144 DOI: 10.1186/s12987-018-0095-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been estimated that paediatric meningitis without elevated CSF white cell count (pleocytosis) accounts for 0.5-12% of all cases of bacterial meningitis. CSF protein and glucose measurements are therefore essential in management but may be neglected in clinical practice. In order to improve recognition of bacterial meningitis in neonates and to enable adequate management and audit, we investigated whether a systemic inflammatory response in the absence of meningitis is associated with elevated CSF protein and reduced CSF glucose levels. A further aim was to determine whether abnormal levels of these parameters were associated with increased incidence of neurological damage. METHODS As part of an audit into management of abnormal CSF findings in neonates, we conducted a retrospective analysis of neonates without meningitis as evident from normal CSF white blood cell counts and negative CSF culture. We compared data from neonates with fever (temperature > 38.0 °C) and/or elevated C-reactive protein (CRP) levels (> 5 mg/l) (possible sepsis) with data from neonates without fever or CRP elevation. RESULTS We analysed results from a total of 244 neonates. CSF protein levels were 0.89 g/l (SD 0.37) in neonates without fever or elevated CRP (n = 26) and not significantly different from neonates with possible sepsis (n = 218) with 0.92 g/l (SD 0.40). CSF glucose levels in infants with possible sepsis were 2.71 (SD 0.83) mmol/l and not significantly different from infants without sepsis with 2.55 mmol/l (SD 0.34). CONCLUSIONS CSF protein and glucose levels are not affected by a systemic inflammatory response syndrome if there is no meningitis.
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Affiliation(s)
- Mona Noureldein
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4ODZ, UK
| | - Roxana Mardare
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4ODZ, UK
| | - Jack Pickard
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4ODZ, UK
| | - Hoi Lun Shing
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4ODZ, UK
| | - Michael Eisenhut
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4ODZ, UK.
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Ouchenir L, Renaud C, Khan S, Bitnun A, Boisvert AA, McDonald J, Bowes J, Brophy J, Barton M, Ting J, Roberts A, Hawkes M, Robinson JL. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics 2017; 140:peds.2017-0476. [PMID: 28600447 DOI: 10.1542/peds.2017-0476] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The pathogens that cause bacterial meningitis in infants and their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B Streptococcus (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in early infancy. METHODS This was a cohort study of infants <90 days of age with bacterial meningitis at 7 pediatric tertiary care hospitals across Canada in 2013 and 2014. RESULTS There were 113 patients diagnosed with proven meningitis (n = 63) or suspected meningitis (n = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogens were Escherichia coli (n = 37; 33%) and GBS (n = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin (E coli and Haemophilus influenzae type B). Six of 60 infants presenting a diagnosis of meningitis from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice (Listeria monocytogenes [n = 3], Enterobacter cloacae, Cronobacter sakazakii, and Pseudomonas stutzeri). Sequelae were documented in 84 infants (74%), including 8 deaths (7%). CONCLUSIONS E coli and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis.
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Affiliation(s)
- Lynda Ouchenir
- Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Christian Renaud
- Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Sarah Khan
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane McDonald
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Jennifer Bowes
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Brophy
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Barton
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Joseph Ting
- British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Ashley Roberts
- British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Michael Hawkes
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Gordon SM, Srinivasan L, Harris MC. Neonatal Meningitis: Overcoming Challenges in Diagnosis, Prognosis, and Treatment with Omics. Front Pediatr 2017; 5:139. [PMID: 28670576 PMCID: PMC5472684 DOI: 10.3389/fped.2017.00139] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/01/2017] [Indexed: 01/24/2023] Open
Abstract
Neonatal meningitis is a devastating condition. Prognosis has not improved in decades, despite the advent of improved antimicrobial therapy and heightened index of suspicion among clinicians caring for affected infants. One in ten infants die from meningitis, and up to half of survivors develop significant lifelong complications, including seizures, impaired hearing and vision, and delayed or arrested development of such basic skills as talking and walking. At present, it is not possible to predict which infants will suffer poor outcomes. Early treatment is critical to promote more favorable outcomes, though diagnosis of meningitis in infants is technically challenging, time-intensive, and invasive. Profound neuronal injury has long been described in the setting of neonatal meningitis, as has elevated levels of many pro- and anti-inflammatory cytokines. Mechanisms of the host immune response that drive clearance of the offending organism and underlie brain injury due to meningitis are not well understood, however. In this review, we will discuss challenges in diagnosis, prognosis, and treatment of neonatal meningitis. We will highlight transcriptomic, proteomic, and metabolomic data that contribute to suggested mechanisms of inflammation and brain injury in this setting with a view toward fruitful areas for future investigation.
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Affiliation(s)
- Scott M Gordon
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lakshmi Srinivasan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Mary Catherine Harris
- Division of Neonatology, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA, United States
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A Case-Control Study on the Risk Factors for Meningococcal Disease among Children in Greece. PLoS One 2016; 11:e0158524. [PMID: 27351742 PMCID: PMC4924850 DOI: 10.1371/journal.pone.0158524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to identify environmental or genetic risk factors that are associated with invasive meningococcal disease (IMD) in children in Greece. Methods A case-control study was performed in 133 children (44 cases and 89 controls) aged between 0–14 years, who were hospitalized in a children's hospital in Athens. Demographics and possible risk factors were collected by the use of a structured questionnaire. To investigate the association of mannose binding lectin (MBL) with IMD, a frequency analysis of the haplotypes of the MBL2 gene and quantitative measurement of MBL serum protein levels were performed using Nanogen NanoChipR 400 technology and immuno-enzyme techniques, respectively. Results The multivariate analysis revealed that changes in a child's life setting (relocation or vacation, OR = 7.16), paternal smoking (OR = 4.51), upper respiratory tract infection within the previous month (OR = 3.04) and the density of people in the house/100m2 (OR = 3.16), were independent risk factors associated with IMD. Overall 18.8% of patients had a MBL2 genotype with low functionality compared to 10.1% of healthy controls, but this was not statistically significant (p = 0.189). Conclusion Prevention strategies aimed at reducing parental smoking and other risk factors identified in this study could decrease the risk of IMD among children in Greece.
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