Survey of neonatal meningitis in Australia: 1987-1989

Multiple brain abscesses in an extremely preterm infant and a 12-year follow up: a case report

BACKGROUND

Brain abscesses are uncommon but life-threatening in extremely preterm (EP, Gestational Age < 28 weeks) infants. The information of long-time follow-up is rare, but very few cases presented almost intact neural function after injury.

CASE PRESENTATION

We report the clinical course and the outcome of a 27-week preterm infant with multiple brain abscesses. The brain abscesses were detected by cranial magnetic resonance imaging (MRI) and were treated with surgical aspiration twice and a 7-week course of intravenous antibiotics. The patient had two episodes of seizure like activities at 8 and 11 years old respectively, whereas she had normal results of electroencephalogram (EEG). MRI showed encephalomalacia and periventricular leukomalacia. Otherwise, she had no obvious neurological deficits based on multiple physical examination and her intellectual quotient (IQ) was in normal range in the long-time follow-up.

CONCLUSIONS

Early diagnosis of brain abscesses and appropriate therapy can improve the prognosis. Furthermore, this case report provides an example of the possible neuroplasticity of brain in EP infants.

Evaluation of the BioFire FilmArray meningitis/encephalitis panel for the detection of bacteria and yeast in Chinese children

Background

Meningitis and encephalitis are life-threatening syndromes with high morbidity and mortality in children. Due to limitations of traditional laboratory approaches in etiological diagnosis, the rate of misdiagnoses is unacceptably high.

Methods

We retrospectively compared the potential clinical impact of the FilmArray meningitis/encephalitis (ME) panel vs. conventional cerebrospinal fluid (CSF) culture in children with central nervous system (CNS) infections. Sixty-eight pediatric patients (<18 years of age) with an initial diagnosis of meningitis or encephalitis were enrolled at 2 children's hospital from January to October 2017.

Results

Fifteen specimens were found to be positive after CSF culture, with a positive rate of 22.1% (15/68). For the FilmArray ME panel, 26 bacteria and fungi from 25 samples were detected, and the positive rate was 36.8% (25/68). The FilmArray ME panel identified 14 pathogens in previously pathogen-negative patients.

Conclusions

This study demonstrated the capability of the FilmArray ME panel in the diagnosis of bacterial and fungal meningitis and therefore its potential use in facilitating enhanced patient care.

Neonatal bacterial meningitis in Tikur Anbessa Specialized Hospital, Ethiopia: a 10-year retrospective review

BACKGROUND

Bacterial meningitis is still a major public health threat in developing countries. It is an overwhelming infection with a high morbidity and mortality rate, especially in neonates. The aim of this study was to determine the prevalence and etiological agents that cause bacterial neonatal meningitis at Tikur Anbessa Specialized Hospital (TASH).

METHODS

This is a retrospective analysis of 1189 cerebrospinal fluid (CSF) specimens submitted to the bacteriology laboratory of TASH for culture from 2001 to 2010. All newborns younger than 29 days old that were suspected for bacterial meningitis cases were included in the study.

RESULTS

Based on CSF culture, 56 newborns were identified as having bacterial meningitis from a total of 1189 suspected cases. The overall prevalence of neonatal bacterial meningitis from the total suspected cases was 4.7%. The organisms identified and their prevalence rates were Streptococcus pneumoniae 13 (23%), Escherichia coli 9 (16%), Acinetobacter 7 (13%), Neisseria meningitides 5 (9%), Klebsiella spp. 5 (9%), Staphylococcus aureus 3 (5%) and Streptococcus pyogen 3 (5%). There were two (4%) cases each that was caused by Coagulase-Negative-Staphylococcus and Non-Group-A-Streptococcus, while 1 (2%) caused by Haemophilus influenzae. S. pneumoniae was the main etiological agent identified from CSF culture. The male to female ratio was 1:0.88 (53% were male). The birth weights of 34 (61%) patients were under 2500 g, and 22 (39%) patients had normal birth weights. Twenty-seven (48%) were early onset cases, and 29 (52%) were late-onset.

CONCLUSION

Streptococcus pneumoniae and Escherichia coli were the two main etiological agents for neonatal bacterial meningitis infection in the study area.

Multiple brain abscesses in neonate caused by Edwardsiella tarda: case report

A neonate presented with multiple brain abscesses caused by very unusual infection with the Gram-negative bacterium, Edwardsiella tarda. Serial changes in magnetic resonance imaging findings including diffusion-weighted imaging demonstrated the development from the late cerebritis to late capsule stages. The patient was successfully treated by external drainage, and has since reached normal development milestones. Early diagnosis with computed tomography, magnetic resonance imaging, and ultrasound tomography, and prompt external drainage were essential to the good outcome of this case.

The role of cranial ultrasound and magnetic resonance imaging in the diagnosis of infections of the central nervous system

Imaging data concerning infection of the central nervous system (CNS) in neonates are usually confined to small groups of infants. We have reviewed the imaging findings in 96 preterm and full-term infants admitted to our neonatal intensive care unit over a 15 year period. Neuro-imaging, especially cranial ultrasound (CUS) and magnetic resonance imaging (MRI) provided useful information; CUS allows the early and later detection of calcification, germinolytic and parenchymal cysts, ventricular dilatation and strands and ependymal abnormality; diffusion weighted imaging (DWI) is especially useful in the acute stage of bacterial and viral infections, while conventional MRI helps in the detection of neocortical dysplasia in CMV infection and defining cerebellar abnormality.

Neonatal meningitis in England and Wales: sequelae at 5 years of age

This study determined the prevalence of serious sequelae among a national cohort of 5-year old children, born in England and Wales in 1996-7, who had had neonatal meningitis. The results were compared with those from two matched control groups. In addition the results from this study were compared with those from a previous 5-year follow-up of children who had had neonatal meningitis in 1985-7. Follow-up questionnaires requesting information about the children's health and development were sent to the general practitioners (GPs) and parents of the index children and controls. Information was collected on 166 of 232 (72%) children who had had meningitis as neonates, 109 general practice controls and 191 hospital controls. At 5 years, 39/166 (23%) index children had a serious disability compared to 2% of GP controls and 7% of hospital controls. There was a 16-fold increase in risk of serious disability compared to GP-matched controls and a 4-fold increase in risk compared to hospital controls. The isolation of bacteria from the CSF was the best single predictor of serious long-term disability. Although there was a 70% fall in acute phase mortality between 1985 (22%) and 1996 (6.6%), the overall incidence of serious disability remained alarmingly high, 25.5% in 1985 compared to 23.5% in 1996. In the present study, however, fewer children had cerebral palsy or seizure disorders.

CONCLUSION

Despite the dramatic improvement in acute phase survival following neonatal meningitis, the prevalence of serious sequelae remains alarmingly high.

Early onset neonatal meningitis in Australia and New Zealand, 1992-2002

OBJECTIVES

To study the epidemiology of early onset neonatal bacterial meningitis (EONBM) in Australasia.

DESIGN

Prospective surveillance study, 1992-2002, in 20 neonatal units in Australia and New Zealand. EONBM was defined as meningitis occurring within 48 hours of delivery.

RESULTS

There were 852 babies with early onset sepsis, of whom 78 (9.2%) had EONBM. The incidence of early onset group B streptococcal meningitis fell significantly from a peak of 0.24/1000 live births in 1993 to 0.03/1000 in 2002 (p trend = 0.002). There was no significant change over time in the incidence of Escherichia coli meningitis. The rate of EONBM in very low birthweight babies was 1.09/1000 compared with the rate in all infants of 0.11/1000. The overall rate of EONBM was 0.41/1000 in 1992 and 0.06 in 2001, but this trend was not significant (p trend = 0.07). Case-fatality rates for EONBM did not change significantly with time. Birth weight <1500 g (odds ratio (OR) 7.2 (95% confidence interval (CI) 4.8 to 10.9)) and Gram negative bacillary meningitis (OR 3.3 (95% CI 2.2 to 4.9)) were significant risk factors for mortality. Sixty two percent of the 129 babies who died from early onset sepsis or suspected sepsis did not have a lumbar puncture performed.

CONCLUSION

The incidence of early onset group B streptococcal meningitis has fallen, probably because of maternal intrapartum antibiotic prophylaxis, without a corresponding change in E. coli meningitis. Gram negative bacillary meningitis still carries a worse prognosis than meningitis with a Gram positive organism.

Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): Review of 10 cases

We evaluated retrospectively, 10 MRSA meningitis cases in our hospital that occurred between January 1999 and June 2004. All were post-neurosurgical and were considered to have hospital-acquired meningitis. Fever, leukocytosis, variable conscious levels were the most common findings. Six patients were treated with regimens including teicoplanin, and four with vancomycin. Mean duration of treatment was 23.5+/-18.8 days (range, 3-60 days). One patient died. In cases of MRSA meningitis, intravenous vancomycin is the mainstay of therapy. However, six of these 10 patients were successfully treated with regimens including teicoplanin, suggesting that this agent may be an alternative to vancomycin in the therapy of these cases.

Neonatal bacterial meningitis in southern Taiwan

To determine the epidemiologic trends, prognostic factors, and therapeutic results of neonatal bacterial meningitis, 60 neonatal patients with culture-proven neonatal bacterial meningitis were enrolled in this study. To compare changes over time, the appearance of disease among the patients was divided into two equal periods (1986-1993 and 1994-2001). Group B streptococci were the most common causative pathogens, accounting for approximately 32% of the episodes. Escherichia coli, the next most common pathogen, was more frequently observed in the second period. Seventy-seven percent of gram-negative bacilli isolates were resistant to ampicillin. Moreover, oxacillin-resistant Staphylococcus and ampicillin-resistant group B streptococci strains occurred in the second periods as late-onset neonatal bacterial meningitis. The overall mortality rates for the first and second study period were 17% and 8%, respectively. However, if individuals with poor outcomes were taken into account, 38% of patients were considered treatment failures. Significant prognostic factors included the presence of seizures, thrombocytopenia, and high cerebrospinal fluid protein and low cerebrospinal fluid glucose concentration. Although the mortality rate was significantly reduced in the second period, there has been increasing incidence of the emergence of resistant strains presenting a therapeutic challenge. The presentation in neonatal bacterial meningitis might be nonspecific, and blood culture results were negative in 45% of the episodes. Early diagnosis, choice of appropriate antibiotics, and correction of metabolic derangement are essential to improving outcomes.

A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units

OBJECTIVE

To study late onset systemic infections with coagulase negative staphylococci.

METHODS

Prospective longitudinal study of coagulase negative staphylococcal infection in 18 Australasian neonatal nurseries.

RESULTS

From 1991 to 2000 inclusive, there were 1281 cases of coagulase negative staphylococcal (CoNS) sepsis, comprising 57.1% of all late onset infections. The male/female ratio was 1.27:1 (p < 0.05). The incidence of CoNS sepsis was 3.46 episodes per 1000 live births. Most infected babies (71%) were 24-29 weeks gestation at birth (mode 26 weeks). The first positive culture was day 7-14 in 49% of babies (mode 10 days). Five cases of meningitis were reported, an incidence of 0.4% of all CoNS infections. Twenty nine babies (2.3%) had concurrent necrotising enterocolitis and CoNS septicaemia. Four babies (0.3%) died from CoNS infection, but CoNS infection possibly contributed to the death of an additional 20 babies (1.6%). The mortality directly attributable to CoNS infection was significantly lower than that from late onset infections with Staphylococcus aureus (13.1%; relative risk (RR) = 36.1 (95% confidence interval (CI) 13.0 to 100.2) or with Gram negative bacilli (14.2%; RR = 45.5 (95% CI 16.8 to 123.3)).

CONCLUSIONS

CoNS are currently responsible for most late onset neonatal infections. Most infected babies are < 30 weeks gestation at birth, and usually present between 7 and 14 days of age. CoNS infections may be associated with necrotising enterocolitis, although causality is unproven. Neonatal CoNS infections are relatively benign: meningitis is rare and mortality low compared with infection from other organisms. Over-vigorous attempts to reduce the incidence of CoNS infections using prophylactic antibiotics are not advisable.

Neonatal meningitis in Addis Ababa: a 10-year review

In a hospital population-based retrospective study of neonatal meningitis, 55 cases were identified over a period of 10 years. The prevalences of meningitis for preterm and term newborns were 3.66 and 0.97 per 1000, respectively (22/6465 vs 33/36638; p < 0.01). The overall prevalence was 1.37 per 1000 live births. Twenty-two (40%) babies with meningitis died, more preterm than term (13/22 vs 9/33; p < 0.05). Known maternal risk factors for neonatal meningitis were observed in 15 (27%) babies. The risk factors were more common in preterm than in term newborns (10/22 vs 5/33; p < 0.05). The common causative organisms were Klebsiella pneumoniae, Escherichia coli and Enterobacter spp. which together accounted for 67% of all CSF isolates. These organisms were evenly distributed between early- and late-onset meningitis, and among term and preterm newborns. Seven of 33 (21%) of the surviving newborns developed neurological complications. The short-term sequelae were hydrocephalus, spastic paresis and seizures.

Neonatal meningitis in England and Wales: a review of routine national data

The objective of this study was to describe trends in neonatal meningitis in England and Wales during the years 1975-91. Laboratory reports and, for the years 1983-91, data on statutory notifications and deaths from neonatal meningitis were reviewed. The mean annual total of laboratory reports of neonatal bacterial meningitis 1975-91 was 109 cases (range 69-133) with a slight upward trend apparent in the latter half of the study period. The mean annual number of reports of neonatal viral meningitis was only 14 cases with no trend apparent. The leading bacteria isolated were group B streptococci, Escherichia coli, and Listeria monocytogenes accounting for 34.1%, 28.5%, and 6.8% of reports, respectively. There was a change in the pattern of causative bacteria from 1981 onwards with the group B streptococcus displacing E coli as the leading cause. With respect to neonatal viral meningitis, echoviruses and coxsackie viruses accounted for 55.4% and 38.6% of cases, respectively. Neonatal meningitis was seriously undernotified; the ratio of laboratory reported cases to cases notified ranged from 12:1 in 1985 to 4:1 in 1989. The annual numbers of deaths ranged from 18 to 39. The laboratory reporting system provided the most useful data on secular trends and causative organisms for neonatal meningitis. The slight upward trend in the number of reports of bacterial meningitis merits continued surveillance.