1
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White S, Katf H, Baird R, Francis J. Temporal trends in paediatric bacterial meningitis in a tropical Australian region: 1992-2014. J Paediatr Child Health 2018; 54:1206-1212. [PMID: 29754466 DOI: 10.1111/jpc.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/02/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
AIM The epidemiology of community-acquired bacterial meningitis has changed following the introduction of routine immunisation against common causative organisms. Indigenous children living in the Northern Territory, Australia, have high rates of bacterial infections. This study describes changes in the epidemiology of childhood bacterial meningitis and the distribution of the burden of disease in the Top End. METHODS A retrospective review of cases derived from hospital medical records and laboratory data was performed. Inclusion criteria were children aged 3 months to 14 years of age, admitted to Royal Darwin Hospital between 1992 and 2014 and diagnosed with bacterial meningitis. Annual incidence of bacterial meningitis and the distribution of causative pathogens are described. Demographic data, investigations, treatment and outcomes were compared between Indigenous and non-Indigenous children. RESULTS There were 137 cases of childhood bacterial meningitis identified over the 23-year period. The incidence reduced from 21 per 100 000 children per year for 1992-2002 to 11 per 100 000 per year for 2003-2014 (P = 0.0025). Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis were the most common causative organisms, with a reduction in cases for each pathogen observed across the study period. Indigenous children were over-represented (104/137, 76%). Case fatality rate was 8% (11/137); 91% of fatal cases presented to a remote facility. CONCLUSIONS The incidence of childhood bacterial meningitis has declined in the Northern Territory of Australia, but Indigenous children are disproportionately affected. Routine immunisation is beneficial for all, although further efforts to 'Close the Gap' between health outcomes in Indigenous and non-Indigenous Australians is required.
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Affiliation(s)
- Stephanie White
- Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Hala Katf
- Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Rob Baird
- Microbiology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua Francis
- Paediatric Departments, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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2
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Beaman MH. Community-acquired acute meningitis and encephalitis: a narrative review. Med J Aust 2018; 209:449-454. [PMID: 30309300 DOI: 10.5694/mja17.01073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 08/31/2018] [Indexed: 12/26/2022]
Abstract
Meningitis and encephalitis are medical emergencies. Patients need prompt evaluation and immediate empiric therapy to reduce the likelihood of fatal outcomes and chronic neurological sequelae. Conjugate bacterial vaccines have significantly reduced the incidence of bacterial meningitis, especially in children. As the results of changes in patterns of bacterial drug sensitivity, ceftriaxone is now part of the recommended empiric treatment for bacterial meningitis and should be administered as early as possible. Neuroimaging delays the treatment of meningitis and is not needed in most cases. Adjunctive corticosteroid therapy is of benefit for many patients with meningitis and should be initiated in most adults before antibiotic therapy. Molecular testing can assist the specific diagnosis of encephalitis and should be based on the exposure history and geographic risk factors relevant to the patient, but non-infectious causes of encephalitis are also common. Empiric therapy for encephalitis should be directed at the most frequently identified infectious pathogen, herpes simplex virus type 1 (ie, intravenous aciclovir). Vaccines can protect against the major pathogens of childhood infections (measles, mumps, rubella, polio, varicella viruses), influenza viruses, and exotic pathogens that cause meningitis and encephalitis (rabies, Japanese encephalitis, dengue, yellow fever, tick-borne encephalitis viruses, Mycobacterium tuberculosis).
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3
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MacDonald B, Diamond Y, McCloskey K, Standish J. Probable acute Epstein-Barr virus encephalitis in a 6-year-old girl. J Paediatr Child Health 2017; 53:1233-1235. [PMID: 28767164 DOI: 10.1111/jpc.13642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Bradley MacDonald
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Yonatan Diamond
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Kate McCloskey
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Jane Standish
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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4
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Britton PN, Eastwood K, Paterson B, Durrheim DN, Dale RC, Cheng AC, Kenedi C, Brew BJ, Burrow J, Nagree Y, Leman P, Smith DW, Read K, Booy R, Jones CA. Consensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand. Intern Med J 2016; 45:563-76. [PMID: 25955462 DOI: 10.1111/imj.12749] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/17/2015] [Indexed: 02/06/2023]
Abstract
Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. Patients with possible meningoencephalitis are often encountered in the emergency care environment where clinicians must consider differential diagnoses, perform appropriate investigations and initiate empiric antimicrobials. For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy?
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Affiliation(s)
- P N Britton
- Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | - K Eastwood
- Health Protection, Hunter New England Population Health, Newcastle, New South Wales, Australia.,Biopreparedness, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - B Paterson
- Biopreparedness, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - D N Durrheim
- Biopreparedness, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - R C Dale
- Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Neurology, The Children's Hospital at Westmead, Sydney, Australia
| | - A C Cheng
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C Kenedi
- Departments of, General Medicine, Auckland City Hospital, Auckland, New Zealand, USA.,Liaison Psychiatry, Auckland City Hospital, Auckland, New Zealand, USA.,Department of Medicine and Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - B J Brew
- St Vincent's Centre for applied medical research, University of New South Wales, Sydney, Australia.,Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - J Burrow
- Department of Neurology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Y Nagree
- Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.,Emergency Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - P Leman
- Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.,Emergency Department, Royal Perth Hospital, Perth, Australia
| | - D W Smith
- Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
| | - K Read
- Department of Infectious Diseases, North Shore Hospital, Auckland, New Zealand, USA
| | - R Booy
- Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - C A Jones
- Discipline of Paediatrics and Child Health and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
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5
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Britton PN, Eastwood K, Brew BJ, Nagree Y, Jones CA. Consensus guidelines for the investigation and management of encephalitis. Med J Aust 2015; 202:576-7. [PMID: 26068688 DOI: 10.5694/mja14.01042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/28/2014] [Indexed: 01/07/2023]
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6
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March B, Eastwood K, Wright IM, Tilbrook L, Durrheim DN. Epidemiology of enteroviral meningoencephalitis in neonates and young infants. J Paediatr Child Health 2014; 50:216-20. [PMID: 24372592 DOI: 10.1111/jpc.12468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/28/2022]
Abstract
AIM To describe the epidemiology of enteroviral meningoencephalitis in northern New South Wales, Australia, with a specific focus on neonatal and young infant cases. METHODS A retrospective review of PCR-confirmed enteroviral meningoencephalitis cases in the Hunter New England Local Health District of northern NSW was conducted for the period 2008-2012. RESULTS One hundred nine patients met the case definition. There was summer seasonality, with 50% (55/109) of cases occurring between December and February. Neonates and young infants (<3 months of age) accounted for 42% (46/109) of cases, with 20% (9/46) being premature births. Fever (83%) was the most common presentation in this age group, followed by irritability (40%), feeding difficulties (40%) and rash (17%). All received at least one antibiotic during their admission, with 26% (12/46) also treated empirically with acyclovir. There was one death. Where testing was undertaken, cerebrospinal fluid (CSF) protein levels were high in 90% (28/31) of neonates and young infants, but the CSF white cell count was variable, with 57% <10/mm(3) and 21% >100/mm(3) . CONCLUSION Early diagnosis of enteroviral meningoencephalitis could alter management, potentially reducing the period of treatment with empirical antimicrobials and permitting earlier discharge.
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Affiliation(s)
- Brayden March
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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7
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Schuh S, Lindner G, Exadaktylos AK, Mühlemann K, Täuber MG. Determinants of timely management of acute bacterial meningitis in the ED. Am J Emerg Med 2013; 31:1056-61. [PMID: 23702055 DOI: 10.1016/j.ajem.2013.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 03/24/2013] [Accepted: 03/24/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose was to study the emergency management of patients with suspected meningitis to identify potential areas for improvement. METHODS All patients who underwent cerebrospinal fluid puncture at the emergency department of the University Hospital of Bern from January 31, 2004, to October 30, 2008, were included. A total of 396 patients were included in the study. For each patient, we analyzed the sequence and timing for the following management steps: first contact with medical staff, administration of the first antibiotic dose, lumbar puncture (LP), head imaging, and blood cultures. The results were analyzed in relation to clinical characteristics and the referral diagnosis on admission. RESULTS Of the 396 patient analyzed, 15 (3.7%) had a discharge diagnosis of bacterial meningitis, 119 (30%) had nonbacterial meningitis, and 262 (66.3%) had no evidence of meningitis. Suspicion of meningitis led to earlier antibiotic therapy than suspicion of an acute cerebral event or nonacute cerebral event (P < .0001). In patients with bacterial meningitis, the average time to antibiotics was 136 minutes, with a range of 0 to 340 minutes. Most patients (60.1%) had brain imaging studies performed before LP. On the other hand, half of the patients with a referral diagnosis of meningitis (50%) received antibiotics before performance of an LP. CONCLUSIONS Few patients with suspected meningitis received antimicrobial therapy within the first 30 minutes after arrival, but most patients with pneumococcal meningitis and typical symptoms were treated early; patients with bacterial meningitis who received treatment late had complex medical histories or atypical presentations.
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Affiliation(s)
- Sabine Schuh
- Institute for Infectious Diseases, University of Bern, 3010 Bern, Switzerland
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8
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Huppatz C, Gawarikar Y, Levi C, Kelly PM, Williams D, Dalton C, Massey P, Givney R, Durrheim DN. Should there be a standardised approach to the diagnostic workup of suspected adult encephalitis? A case series from Australia. BMC Infect Dis 2010; 10:353. [PMID: 21159185 PMCID: PMC3018438 DOI: 10.1186/1471-2334-10-353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 12/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical diagnosis of encephalitis is often difficult and identification of a causative organism is infrequent. The encephalitis syndrome may herald the emergence of novel pathogens with outbreak potential. Individual treatment and an effective public health response rely on identifying a specific pathogen. In Australia there have been no studies to try to improve the identification rate of encephalitis pathogens. This study aims to review the diagnostic assessment of adult suspected encephalitis cases. METHODS A retrospective clinical audit was performed, of all adult encephalitis presentations between July 1998 and December 2007 to the three hospitals with adult neurological services in the Hunter New England area, northern New South Wales, Australia. Case notes were examined for evidence of relevant history taking, clinical features, physical examination, laboratory and neuroradiology investigations, and outcomes. RESULTS A total of 74 cases were included in the case series. Amongst suspected encephalitis cases, presenting symptoms and signs included fever (77.0%), headache (62.1%), altered consciousness (63.5%), lethargy (32.4%), seizures (25.7%), focal neurological deficits (31.1%) and photophobia (17.6%). The most common diagnostic laboratory test performed was cerebrospinal fluid (CSF) analysis (n = 67, 91%). Herpes virus polymerase chain reaction (n = 53, 71.6%) and cryptococcal antigen (n = 46, 62.2%) were the antigenic tests most regularly performed on CSF. Neuroradiological procedures employed were computerized tomographic brain scanning (n = 68, 91.9%) and magnetic resonance imaging of the brain (n = 35, 47.3%). Thirty-five patients (47.3%) had electroencephalograms. The treating clinicians suspected a specific causative organism in 14/74 cases (18.9%), of which nine (12.1%) were confirmed by laboratory testing. CONCLUSIONS The diagnostic assessment of patients with suspected encephalitis was not standardised. Appropriate assessment is necessary to exclude treatable agents and identify pathogens warranting public health interventions, such as those transmitted by mosquitoes and those that are vaccine preventable. An algorithm and guidelines for the diagnostic workup of encephalitis cases would assist in optimising laboratory testing so that clinical management can be best tailored to the pathogen, and appropriate public health measures implemented.
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Affiliation(s)
- Clare Huppatz
- Hunter New England Population Health, NSW Health, Newcastle, New South Wales, Australia
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9
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Liu AP, Chou S, Gomes L, Ng T, Salisbury EL, Walker GL, Packham DR. Progressive meningoencephalitis in a Sudanese immigrant. Med J Aust 2010; 192:413-6. [PMID: 20367592 DOI: 10.5694/j.1326-5377.2010.tb03568.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 02/19/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Adam P Liu
- Westmead Hospital, Sydney, NSW, Australia.
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10
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Merriman S, Paech MJ, Keil AD. Bacterial Contamination in Solution Aspirated from Non-Sterile Packaged Fentanyl Ampoules: A Laboratory Study. Anaesth Intensive Care 2009; 37:608-12. [DOI: 10.1177/0310057x0903700413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iatrogenic meningitis is a rare complication of spinal anaesthesia. It is mandatory to use a technique which minimises the risk of introducing bacteria into the subarachnoid space. Currently available fentanyl ampoules require a careful drawing-up technique, as the outside of the ampoule is not sterile and there is potential to contaminate the contents in the drawing-up process. We designed a pilot laboratory study to determine the extent of bacterial contamination of fentanyl solutions drawn up from non-sterile packaged glass fentanyl ampoules using three different methods: aspirating through a 5 μm filter needle only, aspirating through a 5 μm filter needle after swabbing the neck of the ampoule with isopropyl alcohol and aspirating through an antibacterial filter in addition to the 5 μm filter needle. Ten anaesthetists used each method once, in randomised order, to draw up solution from three different fentanyl ampoules. Samples underwent bacterial culture in blood agar and enrichment broth for 48 hours. No significant growth was seen in any sample. This pilot study did not identify any bacterial contamination of fentanyl solution irrespective of which of the three methods for aspiration was used.
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Affiliation(s)
- S. Merriman
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Anaesthesia Registrar, Department of Anaesthesia and Pain Medicine
| | - M. J. Paech
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Professor of Obstetric Anaesthesia, The School of Medicine and Pharmacology, The University of Western Australia, Perth
| | - A. D. Keil
- Departments of Anaesthesia and Pain Medicine and Microbiology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Head, Department of Microbiology, PathWest Laboratory Medicine, King Edward Memorial Hospital
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11
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Smith BK, Cook MJ, Prior DL. Sinus node arrest secondary to HSV encephalitis. J Clin Neurosci 2007; 15:1053-6. [PMID: 17368030 DOI: 10.1016/j.jocn.2006.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 06/25/2006] [Indexed: 11/25/2022]
Abstract
We report a patient with herpes simplex virus (HSV) encephalitis presenting as recurrent syncope due to sinus node arrest. Although the patient's initial presentation suggested a primary cardiac cause, an eventual diagnosis of HSV encephalitis was supported by computed tomography scan and magnetic resonance imaging, and confirmed by HSV polymerase chain reaction. The mechanism of cardiac arrhythmias in HSV encephalitis remains unclear; however, cardiac monitoring should be considered in all patients in whom the diagnosis is suspected. With diagnosis and appropriate management, a permanent pacemaker is generally not indicated. This case report highlights the importance of considering potentially reversible causes of collapse secondary to sinus node dysfunction beyond primary cardiac causes.
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MESH Headings
- Amygdala/pathology
- Amygdala/physiopathology
- Amygdala/virology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Autonomic Pathways/physiopathology
- DNA, Viral/analysis
- Diagnosis, Differential
- Electrocardiography
- Encephalitis, Herpes Simplex/complications
- Encephalitis, Herpes Simplex/pathology
- Encephalitis, Herpes Simplex/physiopathology
- Female
- Hippocampus/pathology
- Hippocampus/physiopathology
- Hippocampus/virology
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Monitoring, Physiologic
- Sinus Arrest, Cardiac/etiology
- Sinus Arrest, Cardiac/physiopathology
- Syncope/etiology
- Syncope/physiopathology
- Temporal Lobe/pathology
- Temporal Lobe/physiopathology
- Temporal Lobe/virology
- Tomography, X-Ray Computed
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Affiliation(s)
- Belinda K Smith
- Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, 3065, Victoria, Australia.
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12
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Plant L, Wan H, Jonsson AB. Non-lipooligosaccharide-mediated signalling via Toll-like receptor 4 causes fatal meningococcal sepsis in a mouse model. Cell Microbiol 2006; 9:657-69. [PMID: 17026481 DOI: 10.1111/j.1462-5822.2006.00816.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Meningococcal lipooligosaccharide (LOS) is a major inflammatory mediator of fulminant meningococcal sepsis and meningitis with disease severity correlating with circulating concentrations of LOS and proinflammatory cytokines. In this study we show that the proinflammatory response to live meningococci in a mouse model of sepsis involves TLR4, but can develop independently of the expression of LOS. This is supported by data showing that in vivo an isogenic LOS-deficient strain, lpxA, induced equivalent disease severity and similar proinflammatory responses as the serogroup C wild-type parent strain FAM20. This response was abolished in TLR4-/- mice, and neither the wild-type strain of meningococci nor the LOS-deficient mutant was able to cause fatal sepsis in these mice. Mouse survival correlated with low levels of cytokines and chemokines, the chemotactic complement factor C5a and neutrophil levels in blood at 24 h post infection. These data suggest that during meningococcal sepsis the recognition of one or more unidentified non-LOS component(s) by TLR4 is important in stimulating proinflammatory responses, and that fatality associated with meningococcal sepsis in mice is induced by the proinflammatory host response.
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Affiliation(s)
- Laura Plant
- Smittskyddsinstitutet, Swedish Institute for Infectious Disease Control, Karolinska Institutet, Nobelsväg 18, 171 77 Solna, Sweden.
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13
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Matsumoto Y, Morimoto I, Shibutani T, Mukubou M, Shirakawa T, Gotoh A, Kawabata M. Measles encephalitis in early pregnancy and after delivery. J Infect Chemother 2005; 11:97-100. [PMID: 15856379 DOI: 10.1007/s10156-005-0372-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
We present two cases of measles encephalitis, one in early pregnancy and one after delivery. In case 1, the patient became unconscious 6 days after the appearance of a rash and was treated with glycerol and immunoglobulin. In case 2, the patient became unconscious 6 days after the appearance of a rash and was also treated with glycerol and immunoglobulin. Both of them recovered without any neurological sequelae. Pregnancy is a risk factor for severe measles complications, and vaccination should be promoted much more in countries with poor measles control, such as Japan.
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Affiliation(s)
- Yasuyo Matsumoto
- International Center for Medical Research and Treatment, Kobe University School of Medicine, 7-5-1 Kusunoki-cho, Kobe, 650-0017, Japan.
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14
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Abstract
AIMS In children with convulsive status epilepticus (CSE) with fever, to determine the likelihood of acute bacterial meningitis (ABM), the proportion that are treated with antibiotics, and the proportion that have diagnostic CSF sampling. METHODS Patients with an incident episode of CSE with fever were identified as part of an ongoing prospective population based study of CSE in childhood. RESULTS There were 49 incident cases of CSE in the first six months. Ascertainment was 96%. Twenty four had CSE with fever, 16 had early parenteral antibiotics, nine had diagnostic CSF sampling, and four had ABM. The population risk of ABM in CSE with fever was significantly higher than that of short seizures with fever (17% v 1.2%). CONCLUSIONS The classical symptoms and signs of ABM may be absent in CSE with fever. A high index of suspicion for ABM in the child with CSE with fever is paramount. The most appropriate management is suggested to be early parenteral antibiotics and a lumbar puncture when there are no contraindications.
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Affiliation(s)
- R F M Chin
- Neurosciences Unit, Institute of Child Health, University College London, and Great Ormond Street Hospital for Children NHS Trust, London, UK.
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15
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Affiliation(s)
- A Kong
- Department of Radiology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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16
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Saltman DC. Acute community-acquired meningitis and encephalitis. Med J Aust 2002; 177:277; author reply 277. [PMID: 12197828 DOI: 10.5694/j.1326-5377.2002.tb04770.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2002] [Accepted: 06/06/2002] [Indexed: 11/17/2022]
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17
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Saltman DC, Beaman MH, Wesselingh SL. Acute community‐acquired meningitis and encephalitis. Med J Aust 2002. [DOI: 10.5694/j.1326-5377.2002.tb04771.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Miles H Beaman
- Department of Infectious Diseases, Fremantle Hospital, Fremantle, WA
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