1
|
Abd El-Wahab EW, Farrag T, Metwally M. A clinical rule for the prediction of meningitis in HIV patients in the era of combination antiretroviral therapy. Trans R Soc Trop Med Hyg 2021; 114:264-275. [PMID: 31768553 DOI: 10.1093/trstmh/trz107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The diagnosis of meningitis in HIV patients is challenging due to altered immune responses. Diagnostic scoring systems were recently proposed for use in research settings to help prompt and easy differential diagnosis. The objective of this study was to create a clinical prediction rule (CPR) for meningitis in HIV-infected patients and to address the enigma of differentiating bacterial (BM), TB (TBM) and cryptococcal (CCM) meningitis based on clinical features alone, which may be enhanced by easy-to-obtain laboratory testing. METHODS We retrospectively enrolled 352 HIV patients presenting with neurological manifestations suggesting meningitis over the last 18 y (2000-2018). Relevant clinical and laboratory information were retrieved from inpatient records. The features independently predicting meningitis or its different types in microbiologically proven meningitis cases were modelled by multivariate logistic regression to create a CPR in an exploratory data set. The performance of the meningitis diagnostic score was assessed and validated in a subset of retrospective data. RESULTS AIDS clinical stage, injecting drug use, jaundice and cryptococcal antigen seropositivity were equally important as classic meningitic symptoms in predicting meningitis. Arthralgia and elevated cerebrospinal fluid Lactate dehydrogenase (LDH) were strong predictors of BM. Patients with cryptococcal antigenemia had 25 times the probability of having CCM, whereas neurological deficits were highly suggestive of TBM. CONCLUSION The proposed CPRs have good diagnostic potential and would support decision-making in resource-poor settings.
Collapse
Affiliation(s)
- Ekram W Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt
| | - Talaat Farrag
- Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, 21568 Alexandria, Egypt.,Fellow of the Tropical Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Road, 21561 Alexandria, Egypt
| | - Mohammed Metwally
- Department of Endemic and Infectious Diseases, Alexandria Fever Hospital, 21568 Alexandria, Egypt
| |
Collapse
|
2
|
O'Sullivan D, Linnane B, Mostyn A, Jonathan N, Lenihan M, O'Connell NH, Dunne CP. Detection of Neisseria meningitidis in a paediatric patient with septic arthritis using multiplexed diagnostic PCR targeting meningitis/encephalitis (ME). Ann Clin Microbiol Antimicrob 2018; 17:14. [PMID: 29571294 PMCID: PMC5865334 DOI: 10.1186/s12941-018-0268-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is associated with meningitis and septicemia. Septic meningococcal arthritis is relatively uncommon and its diagnosis associated with clinical and microbiological challenges. Early recognition and treatment is required to prevent joint destruction. PURPOSE We describe a case of an eleven-year-old boy with septic arthritis and the first reported use of a multiplexed diagnostic PCR test, capable of simultaneous rapid detection of 14 pathogens directly from CSF samples, to determine presence of N. meningitides in a synovial fluid sample. RESULTS In this case, blood cultures and an aspiration of the joint fluid were negative for microbial growth, but leucocytes were present. Analysis of samples using the multiplexed FilmArray® meningitis/encephalitis panel (MEP) proved positive for N. meningitidis. In parallel, samples forwarded to an accredited reference laboratory confirmed the findings by bacterial 16S rRNA gene amplification and sequencing. Subsequent to these results, empiric treatment with intravenous flucloxacillin was discontinued and oral amoxicillin administered for 1 month. The status of the patient improved with etiology-based antimicrobial therapy. CONCLUSIONS This case demonstrates difficulties associated with clinical and microbiological diagnosis of primary septic meningococcal arthritis. We describe the first successful use of the FilmArray® MEP assay in detection of N. meningitidis in that context.
Collapse
Affiliation(s)
- Donnchadh O'Sullivan
- Department of Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Barry Linnane
- Department of Paediatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Amanda Mostyn
- Department of Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Nteimam Jonathan
- Department of Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Marie Lenihan
- Department of Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| |
Collapse
|
3
|
Oligoarticular Hemarthroses and Osteomyelitis Complicating Pasteurella Meningitis in an Infant. CHILDREN-BASEL 2017; 4:children4100087. [PMID: 29035302 PMCID: PMC5664017 DOI: 10.3390/children4100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/27/2022]
Abstract
A 5-month-old previously healthy female presented with a one-week history of fever and increased fussiness. Her presentation revealed an ill-appearing infant with an exam and cerebrospinal fluid (CSF) studies concerning bacterial meningitis; CSF cultures grew Pasteurella multocida. Additionally, brain magnetic resonance imaging (MRI) demonstrated cervical osteomyelitis. Despite multiple days of antibiotic therapy, she remained febrile with continued pain; MRI showed oligoarticular effusions, and aspiration of these joints yielded bloody aspirates. Evaluations for coagulopathy and immune complex-mediated arthropathy were negative. The patient improved following appropriate antibiotic therapy and spontaneous resolution of hemarthroses, and was discharged to a short-term rehabilitation hospital. P. multocida is a small, encapsulated coccobacillus that is part of the commensal oral flora of animals. It most commonly causes skin infections in humans, yet is a rare cause of meningitis in the pediatric population, especially in children <1 year of age. Transmission due to P. multocida is most commonly due to direct contact with animals. To our knowledge, this is the first case of oligoarticular hemarthroses and cervical osteomyelitis complicating P multocida meningitis. This case highlights the physician’s potential for cognitive bias and premature anchoring, and the resulting implications in delivering excellent patient care.
Collapse
|
4
|
Masson-Behar V, Jacquier H, Richette P, Ziza JM, Zeller V, Rioux C, Coustet B, Dieudé P, Ottaviani S. Arthritis secondary to meningococcal disease: A case series of 7 patients. Medicine (Baltimore) 2017; 96:e7573. [PMID: 28723791 PMCID: PMC5521931 DOI: 10.1097/md.0000000000007573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Arthritis secondary to invasive meningococcemia is rare and has been described as a direct result of bacteremia or as immunoallergic-type arthritis, related to the immune complex. Only a few case series have been reported.This multicenter study aimed to describe the clinical characteristics and therapeutic outcomes of arthritis secondary to meningococcal infection.We performed a 5-year retrospective study. We included all patients with inflammatory joint symptoms and proven meningococcal disease defined by the identification of Neisseria meningitidis in blood, cerebrospinal fluid, or synovial fluid. Septic arthritis was defined by the identification of N meningitidis in joint fluid. Immune-mediated arthritis was considered to be arthritis occurring after at least 1 day of invasive meningococcal disease without positive joint fluid culture.A total of 7 patients (5 males) with joint symptoms and meningococcal disease were identified. The clinical presentation was mainly oligoarticular and the knee was the most frequent joint site. Five patients had septic arthritis and 4 had immune-mediated arthritis; 2 had septic arthritis followed by immune-mediated arthritis. Immune-mediated arthritis occurred 3 to 7 days after meningococcal meningitis, and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) led to improvement without complications.Physicians must be vigilant to the different clinical presentations in patients with arthritis associated with invasive meningococcal disease. If immune-mediated arthritis is suspected, NSAIDs are usually efficient.
Collapse
Affiliation(s)
- Vanina Masson-Behar
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Hervé Jacquier
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Bactériologie-Virologie, Hôpital Lariboisière
| | - Pascal Richette
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Lariboisière
| | - Jean-Marc Ziza
- Service de Rhumatologie et Médecine Interne. Centre de Référence des Infections Ostéo-articulaire complexes. Groupe hospitalier Diaconesses Croix St-Simon
| | - Valérie Zeller
- Service de Rhumatologie et Médecine Interne. Centre de Référence des Infections Ostéo-articulaire complexes. Groupe hospitalier Diaconesses Croix St-Simon
| | - Christophe Rioux
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Maladie infectieuses, Hôpital Bichat, Paris, France
| | - Baptiste Coustet
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Philippe Dieudé
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| | - Sébastien Ottaviani
- Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine
- AP-HP, Service de Rhumatologie, Hôpital Bichat
| |
Collapse
|
5
|
Primary Meningococcal Type C Arthritis: A Case Report and Literature Review. Case Rep Orthop 2017; 2017:4696014. [PMID: 28487799 PMCID: PMC5402246 DOI: 10.1155/2017/4696014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022] Open
Abstract
Acute septic arthritis is a common clinical problem in emergency departments. Primary meningococcal arthritis (PMA) is very rare and few cases are reported in literature. D. B. M. consulted the emergency department for knee pain and fever; analysis showed that the cause was a Neisseria meningitidis type C infection. He received a treatment consisting of 2 arthroscopies and 5 weeks of antibiotics. At five weeks he returned to work and at 2 months he resumed sports (jogging and soccer) without complaints. Primary arthritis of the knee caused by Neisseria meningitidis is very rare. It has a very good response to antibiotics and arthroscopy procedure. Short-term follow-up and functional results are often good or excellent.
Collapse
|
6
|
Straticiuc S, Ignat A, Hanganu E, Lupu VV, Ciubara AB, Cretu R. Neisseria meningitidis Serogroup C Causing Primary Arthritis in a Child: Case Report. Medicine (Baltimore) 2016; 95:e2745. [PMID: 26844522 PMCID: PMC4748939 DOI: 10.1097/md.0000000000002745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Neisseria meningitidis (N. meningitidis) is associated with severe invasive infections such as meningitis and fulminant septicemia. Septic arthritis due to N. meningitidis is rare and bone infections have been reported exceptionally. We report the case of a 1-year old girl who presented with a painful, swollen right knee, accompanied by fever and agitation. Arthrocentesis of the right knee, while patient was under anesthesia, yielded grossly purulent fluid, so we made arthrotomy and drainage. The culture from synovial fluid revealed N. meningitidis, sensitive to Ceftriaxone. The patient received intravenous antibiotherapy with Ceftriaxone. The status of the patient improved after surgical drainage and intravenous antibiotic therapy. She recovered completely after 1 month. CONCLUSION This observation illustrates an unusual presentation of invasive meningococcal infection and the early identification of the bacteria, combined with the correct treatment, prevent the complications and even death.
Collapse
Affiliation(s)
- Sergiu Straticiuc
- From the Pediatric Orthopaedic Department, "St. Mary" Emergency Children Hospital (SS, RC); Pediatrics Department (AI, VVL); Pediatric Surgery Department (EH); and Anatomy Department, University of Medicine and Pharmacy "Gr. T. Popa"; Orthopaedics Clinic, "St. Spiridon" Emergency Clinical Hospital, Iasi, Romania (ABC)
| | | | | | | | | | | |
Collapse
|
7
|
Primary meningococcal polyarthritis in an adult woman. Case Rep Med 2015; 2015:563672. [PMID: 25838827 PMCID: PMC4369937 DOI: 10.1155/2015/563672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 12/02/2022] Open
Abstract
Primary joint infection caused by the Gram-negative bacteria Neisseria meningitidis is rare. Normally, joint involvement comes secondary to meningitis or severe sepsis caused by this agent. When primary arthritis is seen, monoarthritis is the most common presentation. A meningococcal polyarthritis is described in less than 10 case reports according to current literature. This case report aims to briefly review this rare clinical event in an adult woman with no previous history of rheumatological disease. Early diagnosis of polyarthritis caused by meningococcal bacteria usually present a good prognosis when properly treated.
Collapse
|
8
|
Gee C, Tandon T, Avasthi A, Jerwood S, Rao BM, Cavanagh S. Primary meningococcal septic arthritis of the ankle joint: a case report. J Foot Ankle Surg 2014; 53:216-8. [PMID: 24556490 DOI: 10.1053/j.jfas.2013.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Indexed: 02/03/2023]
Abstract
We present the case of a healthy 18-year-old female who presented with history of an acute onset, painful, swollen right ankle joint. Microbiologic samples from the ankle aspirate grew Neisseria meningitidis. She had had no previous contact with a patient with meningitis nor any existing or preceding clinical symptoms of meningitis. She was treated with surgical drainage with mini-open arthrotomy and a repeat washout at 48 hours. The identification of the organism was expedited using the Analytical Profiling Index (bioMérieux UK, Basingstoke, UK). Our patient was treated with 2 weeks of third-generation cephalosporin antibiotics. At the final follow-up visit, the inflammatory markers had returned to normal, with a normal ankle joint and no evidence of long-term sequelae of septic arthritis. Primary septic arthritis with N. meningitidis is exceptionally rare in the adult population and has been most often reported in the knee. To the best of our knowledge, this is the first reported case of primary septic arthritis of the native adult ankle joint in a healthy individual due to N. meningitides that was diagnosed and treated appropriately with no residual sequelae of the disease.
Collapse
Affiliation(s)
- Christopher Gee
- Specialist Registrar, Trauma and Orthopaedics, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom.
| | - Tarang Tandon
- Specialist Registrar, Trauma and Orthopaedics, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom
| | - Adish Avasthi
- Specialist Registrar, Trauma and Orthopaedics, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom
| | - Susie Jerwood
- Consultant Microbiologist, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom
| | - Biyyam M Rao
- Consultant, Trauma and Orthopaedics, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom
| | - Simon Cavanagh
- Consultant, Trauma and Orthopaedics, Western Sussex Hospitals National Health Service Foundation Trust, St. Richards Hospital, Chichester, West Sussex, United Kingdom
| |
Collapse
|