Group A Streptococcal meningitis in children: a short case series and systematic review.

BACKGROUND: Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited. PURPOSE: To gain a better understanding about GAS meningitis. METHODS: Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized. RESULTS: Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%. CONCLUSIONS: A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.

Clinical Characteristics and Outcome Analysis of 94 Children With Brain Abscess in Beijing: A Single-center Retrospective Study.

BACKGROUND: There are limit studies about pediatric brain abscess in China. The aim of this study was to analyze clinical characteristics and outcomes of pediatric brain abscess in recent years in China. METHODS: The clinical information of children with brain abscess hospitalized in Beijing Children's Hospital between January 1, 2007 and December 31, 2016 were retrospectively reviewed. RESULTS: Ninety-four children were enrolled in this study. A Streptococcus milleri group (13.8%) was identified as the most common causative organisms, followed by Staphylococcus aureus (6.4%). The overall mortality was 21.6%, with 50.0% of deaths happening in the first week after diagnosis. Long-term outcomes of 74 patients were assessed with Glasgow Outcome Scale-Extended Pediatric Reversion: 50 patients with a score of 1-2 (favorable outcome) and 24 patients with a score of 3-8 (unfavorable outcome). Patients with multiple abscesses (P = 0.029) and intraventricular rupture of brain abscess/hydrocephalus (P = 0.024) had higher risk of unfavorable outcomes. CONCLUSIONS: Brain abscess is a serious disease with high mortality in children; more aggressive treatments should be considered in the first week of diagnosis because of high risk of death, and for patients with multiple brain abscesses and intraventricular rupture of brain abscess/hydrocephalus because of their higher risk of unfavorable.

[Effect of penetrative needling of otopoints combined with body acupuncture on limb myodynamia and neurofunction in patients with acute cerebral infarction].

OBJECTIVE: To compare the therapeutic effects of different acupuncture methods in improving the myodynamia and neuronfunction of patients with acute cerebral infarction (ACI). METHODS: A total of 90 ACI patients were randomized into ear-acupuncture, scalp-acupuncture and body-acupuncture groups, with 30 cases in each. For patients of ear-acupuncture group, the main otopoints used for penetrative needling were Zhen(MA-AT)-Nie(MA-AT)-E(MA-AT) on the affected side in combination with Jian(MA-SF 4)-Suogu(MA-SF 5) and Zhou(MA-SF 3)-Wan(MA-SF 2)-Zhi(MA-SF 1) for upper-limb paralysis, and with Tun (MA-AH 5)-Zuogushenjing(MA-AH 6), Kuan(MA-AH 4)-Xi(MA-AH 3), and Xi(MA-AH 3)-Huai(MA-AH 2)-Zhi(MA-AH 1) for lower-limb paralysis, and body acupoints as Jianyu(LI 15), Hegu(LI 4), Huantiao(GB 30), Taixi(KI 3), etc. For patients of scalp-acupuncture group, scalp-points used were Dingnie Qianxiexian(MS 6) and Dingnie Houxiexian(MS 7) on the healthy side, and combined with body acupoints (the same as those mentioned above). For patients of body-acupuncture group, only body acupoints were used. The treatment was given once daily for 14 days. RESULTS: Comparison among 3 groups showed that the increased myodynamia of both upper and lower limbs in ear-acupuncture and scalp-acupuncture groups was significantly superior to that of body-acupuncture group (P < 0.01). The neurofunctional deficit scores of ear-acupuncture and scalp-acupuncture groups were significantly lower than that of body-acupuncture group (P < 0.01) after the treatment. In comparison with pre-acupuncture, the neurofunctional deficit scores of the 3 groups lessened considerably after the treatment (P < 0.01). Of the 30 cases in each of earacupuncture, scalp-acupuncture and body-acupuncture groups, 0, 1 and 0 were cured basically, 21, 18 and 4 experienced marked improvement, 9, 11 and 20 were improved, 0, 0 and 6 failed, respectively. The therapeutic effects of ear-acupuncture and scalp-acupuncture were obviously superior to that of body-acupuncture group (P < 0.01). No significant differences were found between ear-acupuncture and scalp-acupuncture groups in myodynamia improvement, neurofunctional deficit scores and clinical curative effect (P > 0.05). CONCLUSION: Acupuncture can effectively improve ACI patients' clinical symptoms and the therapeutic effect of ear-acupuncture and scalp-acupuncture was superior to that of simple body acupuncture.