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Humayun MB, Khalid S, Khalid H, Zahoor W, Malik WT. Post-COVID-19 Encephalitis With Claustrum Sign Responsive to Immunomodulation. Cureus 2023; 15:e35363. [PMID: 36974244 PMCID: PMC10039761 DOI: 10.7759/cureus.35363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
We describe a case of encephalitis following coronavirus disease 2019 (COVID-19) in a six-and-a-half-year-old girl who presented with acute onset confusion and jerky movements of the limbs. The patient was unvaccinated for COVID-19. Subsequent magnetic resonance imaging revealed a bilateral "claustrum sign" on T2 and fluid-attenuated inversion recovery (FLAIR) images and electroencephalogram reported moderate diffuse encephalopathy. The patient tested negative for COVID-19 by polymerase chain reaction, had positive serology for COVID-19 indicating past infection, and had a negative autoimmune panel and infectious workup. She was treated on the lines of post-infectious encephalitis with immunomodulatory therapies such as high-dose intravenous steroids and intravenous immunoglobulins. She responded significantly and had complete resolution of her symptoms; therefore, further supporting the suspicion of an immune-mediated etiology. Cases of post-COVID-19 encephalitis have been reported all over the world; however, most cases are based on speculation and temporal associations and therefore more research is required to optimize treatment guidelines.
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Lubarski K, Mania A, Małecki P, Mazur-Melewska K, Figlerowicz M. Inflammatory Markers Combined With Metalloproteinase-9, Neopterin, and S100B Concentrations May Indicate the Pathogenesis of Central Nervous System Diseases in Children. J Child Neurol 2022; 37:707-716. [PMID: 35722724 DOI: 10.1177/08830738221106663] [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: 11/16/2022]
Abstract
The identification of central nervous system inflammation etiology leads to adjusted therapy. We analyzed the potential inflammatory and neuro-axonal damage markers in children. Our target was to correlate the findings with a disease's course or a sequalae risk and assess their clinical usefulness. The study included 96 children with symptoms of central nervous system inflammation who underwent diagnostics. The research group involved 24 children with autoimmune disorders and 31 with neuroinfection. The control group included patients with both etiologies excluded. We analyzed the results of routine laboratory tests together with chosen serum (neopterin, interleukin [IL]-1β, IL-6) and CSF (metalloproteinase [MMP]-9, S100B protein) markers. In the whole cohort, CSF MMP-9 correlated with CSF cytosis and serum IL-6 and CRP. In the undivided neuroinflammatory group, CSF S100B correlated with serum IL-6 and IgM concentrations. CSF cytosis was associated with CSF MMP-9 and serum neopterin levels. Among the infective patients, IL-6 was linked with increased CSF MMP-9. We conclude that astroglial protein S100B, neopterin, and cytokine concentrations may enable predicting long-term consequences, whereas CSF MMP-9 concentration may reflect the actual central nervous system injury regardless of etiology.
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Affiliation(s)
- Karol Lubarski
- Department of Infectious Diseases and Child Neurology, 37807Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology, 37807Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Małecki
- Department of Infectious Diseases and Child Neurology, 37807Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, 37807Poznan University of Medical Sciences, Poznan, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, 37807Poznan University of Medical Sciences, Poznan, Poland
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Oguni K, Yaegashi M. Fever with no elevation in inflammatory markers: herpes simplex virus encephalitis. QJM 2021; 114:326-327. [PMID: 33486506 DOI: 10.1093/qjmed/hcab012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Oguni
- From the Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture 296-8602, Japan
| | - M Yaegashi
- From the Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba Prefecture 296-8602, Japan
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Alamarat Z, Hasbun R. Management of Acute Bacterial Meningitis in Children. Infect Drug Resist 2020; 13:4077-4089. [PMID: 33204125 PMCID: PMC7667001 DOI: 10.2147/idr.s240162] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/19/2020] [Indexed: 01/22/2023] Open
Abstract
Acute community-acquired bacterial meningitis (ABM) in children continues to have high rates of neurological morbidity and mortality despite the overall declining rates of infection attributed to the use of vaccines and intrapartum Group B Streptococcus prophylaxis. Prompt diagnosis and early antibiotic therapy are crucial and should not be delayed to obtain cranial imaging. Differentiating bacterial from viral meningitis continues to be a clinical dilemma especially in patients with previous antibiotic exposure. Clinical models and inflammatory biomarkers can aid clinicians in their diagnostic approach. Multiplex polymerase chain reaction and metagenomic next-generation sequencing are promising tools that can help in early and accurate diagnosis. This review will present the epidemiology of ABM in children, indications of cranial imaging, role of different models and serum biomarkers in diagnosing ABM, and management including the use of adjunctive therapies and methods of prevention.
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Affiliation(s)
- Zain Alamarat
- Division of Infectious Diseases, Department of Pediatrics, UT Health, McGovern Medical School, Houston, TX, USA
| | - Rodrigo Hasbun
- Division of Infectious Diseases, Department of Internal Medicine, UT Health, McGovern Medical School, Houston, TX, USA
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Berangi Z, Karami M, Mohammadi Y, Nazarzadeh M, Zahraei SM, Javidrad H, Heidari S. Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction. BMC Pediatr 2019; 19:370. [PMID: 31640619 PMCID: PMC6806508 DOI: 10.1186/s12887-019-1741-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No reliable and comprehensive study has been published on the incidence and epidemiological profile of meningitis in Iran from 2008 to 2014, before pneumococcal conjugate vaccine (PCV) and pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed)) introduction. The present study aimed to portray the epidemiological profile of meningitis in Iran from 2008 to 2014. METHODS Data on meningitis cases aged from 1 day to 110 years were extracted from national notifiable diseases surveillance system from March 2008 to December 2014 in Iran. A total number of 48,006 cases of suspected meningitis were identified and 1468 cases of which met the criteria for diagnosis-confirmed meningitis. Of 1468 cases, 1352 patients were included in the study. RESULTS The great number of cases reported from urban areas. Moreover, males were more predominant than females (58.51% vs. 33.81%) in total. The estimated annual incidence rate of meningitis varied from 0.28/100000 in 2008 to 0.09/100000 in 2014. Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis were the most leading pathogens causing bacterial meningitis, accounted for 266(23.44%), 145(12.78%), 95(8.37%) of cases, respectively. Each of the three bacterial species showed a descending trend. The majority of infected subjects are children under five years. CONCLUSIONS Unlike the decreasing trend of meningitis and high percentage of cultures with negative results, according to World Health Organization recommendation PCV introduction into routine immunization is evident. Implementing an enhanced surveillance system to provide high quality data on epidemiological profile of meningitis in Iran is necessary.
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Affiliation(s)
- Zeinab Berangi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran. .,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Younes Mohammadi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Milad Nazarzadeh
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Hamidreza Javidrad
- Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran
| | - Saber Heidari
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, 65178-3-8736, Iran
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Zheng G, Ji X, Yu X, Liu M, Huang J, Zhang L, Guo D, Zhang G. Development and verification of a discriminate algorithm for diagnosing post-neurosurgical bacterial meningitis-A multicenter observational study. J Clin Lab Anal 2019; 34:e23069. [PMID: 31602678 PMCID: PMC7031544 DOI: 10.1002/jcla.23069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF)–based routine clinical examinations for post‐neurosurgical bacterial meningitis (PNBM) in multicenter post‐neurosurgical patients. Methods The diagnostic accuracies of routine examinations to distinguish between PNBM and post‐neurosurgical aseptic meningitis (PNAM) were evaluated by determining the values of the area under the curve (AUC) of the receiver operating characteristic curve in a retrospective analysis of post‐neurosurgical patients in four centers. Results An algorithm was constructed using the logistic analysis as a classical method to maximize the capacity for differentiating the two classes by integrating the measurements of five variables. The AUC value of this algorithm was 0.907, which was significantly higher than those of individual routine blood/CSF examinations. The predicted value from 70 PNBM patients was greater than the cutoff value, and the diagnostic accuracy rate was 75.3%. The results of 181 patients with PNAM showed that 172 patients could be correctly identified with specificity of 95.3%, while the overall correctness rate of the algorithm was 88.6%. Conclusions Routine biomarkers such as CSF/blood glucose ratio (C/B‐Glu), CSF lactate (C‐Lac), CSF glucose concentration (C‐Glu), CSF leukocyte count (C‐Leu), and blood glucose concentration (B‐Glu) can be used for auxiliary diagnosis of PNBM. The multicenter retrospective research revealed that the combination of the five abovementioned biomarkers can effectively improve the efficacy of the PNBM diagnosis.
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Affiliation(s)
- Guanghui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Xufeng Ji
- Department of Clinical Diagnosis, Laboratory of the First Hospital of Jilin University, Changchun, China
| | - Xiaochen Yu
- Laboratory Diagnosis Department of the Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Min Liu
- Daqing Oilfield General Hospital Clinical Laboratory, Daqing, China
| | - Jing Huang
- Department of Clinical Diagnosis, Laboratory of the First Hospital of Jilin University, Changchun, China
| | - Lina Zhang
- Daqing Oilfield General Hospital Clinical Laboratory, Daqing, China
| | - Dawen Guo
- Laboratory Diagnosis Department of the Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guojun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
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Zhao Z, Hua X, Yu J, Zhang H, Li J, Li Z. Duration of empirical therapy in neonatal bacterial meningitis with third generation cephalosporin: a multicenter retrospective study. Arch Med Sci 2019; 15:1482-1489. [PMID: 31749877 PMCID: PMC6855170 DOI: 10.5114/aoms.2018.76938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The duration of treatment is not well established, especially in the negative cerebrospinal fluid (CSF) culture. The aim of this study is to explore the influence of duration of treatment in neonatal bacterial meningitis. MATERIAL AND METHODS This is a retrospective analysis of 200 CSF specimens. Two hundred full-term neonates with bacterial meningitis admitted to the clinical status were evaluated using the Glasgow Outcome Scale (GOS) on the day of discharge. RESULTS Neonates were identified as having bacterial meningitis based on the results of CSF culture tests of all suspected cases. According to the GOS, neonates were divided into two outcome groups: 77.5% good (GOS = 5) (shorter than 3 weeks' administration) and 22.5% unfavorable (GOS = 1-4) (longer than 3 weeks' administration). The duration of antibiotic treatment ranged from 4 to 43 days, and the mean therapy time was 19.74 ±7.32 days. Duration longer than 3 weeks for neonatal bacterial meningitis with negative CSF culture had no impact on prognosis. The unfavorable outcome group had more prenatal infections and premature rupture of membranes cases than the good outcome group. High CSF protein and CSF glucose and CSF cell count increase were associated with unfavorable outcome in 167 non-prenatal infection infants. High CSF cell count increase was associated with unfavorable outcome in 33 prenatal infection infants. In term infants, the positive rate of blood cultures was 24.5%. CONCLUSIONS Third generation cephalosporin therapy does not have a different prognosis for negative CSF culture of neonatal bacterial meningitis in term infants in this study.
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Affiliation(s)
- Zhi Zhao
- Department of Neonatology, Shanxi Province People’s Hospital, Xi’an, Shanxi Province, China
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xueying Hua
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jialin Yu
- Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, China
| | - Haibo Zhang
- Department of Neonatology, Children’s Hospital of Xi’an, Xi’an, Shanxi Province, China
| | - Juhua Li
- Department of Neonatology, Children’s Hospital of Xianyang, Xianyang, Shanxi Province, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women and Children’s Hospital, Xi’an, Shanxi Province, China
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Utility of Clinical and Laboratory Decision Rules in Identifying Bacterial Meningitis Among Children with Suspicion of Central Nervous System Infections in a Malaria-Endemic Area, Mbarara, Uganda. Pediatr Infect Dis J 2019; 38:e131-e133. [PMID: 30199480 DOI: 10.1097/inf.0000000000002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Several decision rules combining clinical and biological parameters have been proposed to distinguish bacterial from aseptic meningitis, but have not been evaluated in Africa. In children hospitalized with suspected central nervous system infections in Uganda, we found that the Bacterial Meningitis Score and Meningitest showed lower performance than in European children, and that a decision rule designed specifically using parameters associated with bacterial meningitis also showed inadequate diagnostic performance for clinical use.
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Elkholy S, Mansour DA, El-Hamid S, Al-Jarhi UM, El-Nahaas SM, Mogawer S. Risk index for early infections following living donor liver transplantation. Arch Med Sci 2019; 15:656-665. [PMID: 31110531 PMCID: PMC6524199 DOI: 10.5114/aoms.2019.84736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 04/30/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Post-operative infections in patients undergoing living donor liver transplantation (LDLT) are a major cause of morbidity and mortality. This study aims to develop a practical and efficient prognostic index for early identification and possible prediction of post-transplant infections using risk factors identified by multivariate analysis. MATERIAL AND METHODS One hundred patients with post-hepatitic cirrhosis, HCV positive, genotype 4, Child B/C or MELD score 13-25 undergoing LDLT were included. All potential predictors of infection were analyzed by backward logistic regression. Cut-off values were obtained from ROC curve analysis. Significant predictors were combined into a risk index, which was further tested and compared by ROC curve analysis. RESULTS Post-operative infection was associated with a significantly higher mortality (50.7% vs. 33.3%). Total leucocyte count, total bilirubin, early biliary complications, fever and C-reactive protein were found to be independent predictors of early infectious complications after LDLT. The risk index predicted infection with the highest sensitivity and specificity as compared with each predictor on its own (AUC = 0.91, 95% CI: 0.830-0.955, p < 0.0001). CONCLUSIONS The use of a combined risk index for early diagnosis of post-operative infections can efficiently identify high risk patients.
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Affiliation(s)
- Shaimaa Elkholy
- Internal Medicine Department, Gastroenterology Division, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ahmed Mansour
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - SamahAbd El-Hamid
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ula M. Al-Jarhi
- Internal Medicine Department, Gastroenterology Division, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Saeed M. El-Nahaas
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif Mogawer
- Internal Medicine Department, Gastroenterology Division, Faculty of Medicine, Cairo University, Cairo, Egypt
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Chauzy A, Nadji A, Combes JC, Defrance N, Bouhemad B, Couet W, Chavanet P. Cerebrospinal fluid pharmacokinetics of ceftaroline in neurosurgical patients with an external ventricular drain. J Antimicrob Chemother 2019; 74:675-681. [PMID: 30535190 DOI: 10.1093/jac/dky489] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Owing to its antibacterial properties, ceftaroline could be attractive for prevention or treatment of bacterial post-neurosurgical meningitis/ventriculitis. However, few data are available concerning its meningeal concentrations. OBJECTIVES To investigate ceftaroline CSF pharmacokinetics in ICU patients with an external ventricular drain (EVD). METHODS Patients received a single 600 mg dose of ceftaroline as a 1 h intravenous infusion. Blood and CSF samples were collected before and 0.5, 1, 3, 6, 12 and 24 h after the end of the infusion. Concentrations were assayed in plasma and CSF by LC-MS/MS. A two-step compartmental pharmacokinetic analysis was conducted. Ceftaroline plasma data were first analysed, and thereafter plasma parameters estimated and corrected for protein binding of 20% were fixed to fit unbound CSF concentrations. In the final model, parameters for both plasma and CSF data were simultaneously estimated. RESULTS Nine patients with an EVD were included. The Cmax was 18.29 ± 3.33 mg/L in plasma (total concentrations) and at 0.22 ± 0.17 mg/L in CSF (unbound concentration). The model-estimated CSF input/CSF output clearance ratio was 9.4%, attesting to extensive efflux transport at the blood-CSF barrier. CONCLUSIONS Ceftaroline CSF concentrations are too low to ensure prophylactic protection against most pathogens with MICs between 1 and 2 mg/L, owing to its limited central distribution.
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Affiliation(s)
- Alexia Chauzy
- Université de Poitiers, INSERM U1070, CHU Poitiers, Poitiers, France
| | | | | | - Nadine Defrance
- Neuroréanimation, Hôpital du Bocage, CHU Dijon, Dijon, France
| | - Belaid Bouhemad
- Neuroréanimation, Hôpital du Bocage, CHU Dijon, Dijon, France
| | - William Couet
- Université de Poitiers, INSERM U1070, CHU Poitiers, Poitiers, France
| | - Pascal Chavanet
- Département d'Infectiologie, CHU and INSERM CIC1432, Université de Bourgogne, Dijon, France
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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12
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Baud MO, Vitt JR, Robbins NM, Wabl R, Wilson MR, Chow FC, Gelfand JM, Josephson SA, Miller S. Pleocytosis is not fully responsible for low CSF glucose in meningitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e425. [PMID: 29296633 PMCID: PMC5745359 DOI: 10.1212/nxi.0000000000000425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/03/2017] [Indexed: 12/14/2022]
Abstract
Objective The mechanism of hypoglycorrhachia-low CSF glucose-in meningitis remains unknown. We sought to evaluate the relative contribution of CSF inflammation vs microorganisms (bacteria and fungi) in lowering CSF glucose levels. Methods We retrospectively categorized CSF profiles into microbial and aseptic meningitis and analyzed CSF leukocyte count, glucose, and protein concentrations. We assessed the relationship between these markers using multivariate and stratified linear regression analysis for initial and repeated CSF sampling. We also calculated the receiver operating characteristics of CSF glucose and CSF-to-serum glucose ratios to presumptively diagnose microbial meningitis. Results We found that increasing levels of CSF inflammation were associated with decreased CSF glucose levels in the microbial but not aseptic category. Moreover, elevated CSF protein levels correlated more strongly than the leukocyte count with low CSF glucose levels on initial (R2 = 36%, p < 0.001) and repeated CSF sampling (R2 = 46%, p < 0.001). Hypoglycorrhachia (<40 mg/dL) was observed in 50.1% of microbial cases, but only 9.6% of aseptic cases, most of which were neurosarcoidosis. Absolute CSF glucose and CSF-to-serum glucose ratios had similar low sensitivity and moderate-to-high specificity in diagnosing microbial meningitis at thresholds commonly used. Conclusions The main driver of hypoglycorrhachia appears to be a combination of microbial meningitis with moderate to high degrees of CSF inflammation and proteins, suggesting that the presence of microorganisms capable of catabolizing glucose is a determinant of hypoglycorrhachia in meningitis. A major notable exception is neurosarcoidosis. Low CSF glucose and CSF-to-serum glucose ratios are useful markers for the diagnosis of microbial meningitis.
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Affiliation(s)
- Maxime O Baud
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Jeffrey R Vitt
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Nathaniel M Robbins
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Rafael Wabl
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Michael R Wilson
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Felicia C Chow
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Jeffrey M Gelfand
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - S Andrew Josephson
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
| | - Steve Miller
- Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine
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