Assuntos
Meningites Bacterianas , Recidiva , Humanos , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/complicações , Meningites Bacterianas/microbiologia , Meningites Bacterianas/etiologia , Meningocele/diagnóstico , Meningocele/complicações , Meningocele/etiologia , Encefalocele/diagnóstico , Encefalocele/etiologia , Feminino , Masculino , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/complicações , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/microbiologiaRESUMO
BACKGROUND AND OBJECTIVES: After neurosurgery, intracranial infection is a common complication with high rates of clinical impairment and death. Traditional diagnostic approaches are time-consuming. Early and correct diagnosis improves infection control, treatment success, and survival. Novel markers are used to diagnose and classify post-neurosurgical meningitis (PNM) to overcome the difficulties of diagnosing postoperative intracranial infections and avoid the drawbacks of existing diagnostic measures. The objective was to investigate the diagnostic value of ß-2 transferrin (ß-2TF) and transferrin (TF) in the cerebrospinal fluid (CSF) for the identification of intracranial infection after neurosurgery. METHODS: Owing to their symptoms and laboratory results, 168 patients with suspected intracranial infection after neurosurgery were divided into 3 groups: post-neurosurgical bacterial meningitis (PNBM; n = 61), post-neurosurgical aseptic meningitis (PNAM; n = 45), and non-PNM (n = 62). We measured lactate (LA), ß-2TF, and TF levels in the CSF. RESULTS: CSF LA levels were significantly higher in the PNM, PNBM, and PNAM groups compared with the non-PNM group ( P < .05). The CSF ß-2TF level in PNM, PNBM, and PNAM were statistically higher than those in non-PNMs ( P < .05). CSF TF levels in the PNBM group were statistically higher than those in the PNAM and non-PNM groups ( P < .05). The PNBM and non-PNM receiver operating curve (ROC) analysis indicates that the cutoff values for the combination (LA, ß-2TF, TF) was 0.349, and the area under the curve (AUC) was 0.945 ( P < .0001), with 92.86% sensitivity and 92.98% specificity. The PNAM and non-PNM ROC analysis indicates that the cutoff values for the combination (LA, ß-2TF, TF) was 0.346, and the AUC was 0.962 ( P < .0001), with 89.29% sensitivity and 90.24% specificity. The PNM and non-PNM ROC analysis indicates that the cutoff values for the combination (LA, ß-2TF, TF) was 0.609, and the AUC was 0.941 ( P < .0001), with 96.36% sensitivity and 82.83% specificity. A Glasgow Coma Scale score ≤8, LA, ß-2TF/TF ratio, length of hospital stay, intensive care unit admission, poor surgical wound, and craniotomy were associated with poor outcomes ( P < .05). LA and ß-2TF were independent risk factors for intracranial infection. CONCLUSION: Postoperative cerebral infections can be identified using CSF ß-2TF as a particular marker protein. CSF TF helps distinguish PNBM from PNAM. Combining CSF LA with them improves diagnostic speed, sensitivity, and accuracy. LA and ß-2TF were independent risk factors for cerebral infection.
Assuntos
Meningites Bacterianas , Neurocirurgia , Humanos , Transferrina , Procedimentos Neurocirúrgicos/efeitos adversos , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/etiologia , Meningites Bacterianas/líquido cefalorraquidiano , Craniotomia/efeitos adversos , Ácido Láctico/líquido cefalorraquidiano , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Curva ROCRESUMO
Objective: To understand the characteristics of bacterial meningitis after pediatric neurosurgical procedures. Methods: This was a retrospective observational study. From January 2016 to December 2022, 64 children diagnosed with post-neurosurgical bacterial meningitis based on positive cerebrospinal fluid (CSF) culture in Department of Neurosurgery of Shanghai Children's Medical Center were selected as the study population. The clinical characteristics, onset time, routine biochemical indexes of cerebrospinal fluid before anti infection treatment, bacteriology characteristics and sensitivity to antibiotics of bacteria cultured from cerebrospinal fluid were analyzed. Based on the CSF culture results, the patients were divided into the Gram-positive bacteria infection group and the Gram-negative bacteria infection group. The clinical characteristics of the two groups were compared using t-tests or Wilcoxon rank-sum tests, and chi-square tests. Results: There were 64 children,42 boys and 22 girls, with onset age of 0.83 (0.50, 1.75) years. Seventy cases of post-neurosurgical bacterial meningitis occurred in the 64 children, of which 15 cases (21%) in spring, 23 cases (33%) in summer, 19 cases (27%) in autumn, and 13 cases (19%) in winter. The time of onset was 3.5 (1.0, 10.0) months after surgery; 15 cases (21%) occurred within the first month after the surgery, and 55 cases (79%) occurred after the first month. There were 38 cases (59%) showing obvious abnormal clinical manifestations, fever 36 cases (56%), vomiting 11 cases (17%). Forty-eight cases (69%) were caused by Gram-positive bacteria, with Staphylococcus epidermidis 24 cases; 22 cases (31%) were caused by Gram-negative bacteria, with Acinetobacter baumannii the prominent pathogen 7 cases. The Gram-positive bacterial infection was more common in summer than the Gram-negative bacterial infection (20 cases (42%) vs. 3 cases (14%), χ2=5.37, P=0.020), while the Gram-negative bacterial infection was more in autumn and within the first month after surgery than the Gram-positive bacterial infection (11 cases (50%) vs. 8 cases (17%), 15 cases (67%) vs. 5 cases (33%), χ2=8.48, 9.02; P=0.004, 0.003). Gram-positive bacteria resistant to vancomycin and Acinetobacter baumannii resistant to polymyxin were not found. However, Acinetobacter baumannii showed only 45% (10/22) susceptibility to carbapenem antibiotics. Conclusions: The clinical presentation of post-neurosurgical bacterial meningitis in children is atypical. Gram-positive bacteria are the main pathogens causing post-neurosurgical bacterial meningitis; Gram-negative bacterial meningitis are more likely to occur in autumn and within the first month after surgery. Acinetobacter baumannii has a high resistance rate to carbapenem antibiotics, which should be taken seriously.
Assuntos
Infecções por Bactérias Gram-Negativas , Infecções por Bactérias Gram-Positivas , Meningites Bacterianas , Masculino , Feminino , Humanos , Criança , China/epidemiologia , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/etiologia , Meningites Bacterianas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Bactérias Gram-Positivas , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Carbapenêmicos , Estudos Retrospectivos , Testes de Sensibilidade Microbiana , Farmacorresistência BacterianaRESUMO
Bacterial meningitis after percutaneous radiofrequency trigeminal ganglion is a rare but severe complication. In this article, we report a case of meningitis due to Streptococcus parasanguinis and review the related literature. A 62-year-old male patient with uremia and severe trigeminal neuralgia presented to another hospital and was offered to undergo radiofrequency treatment for a trigeminal ganglion lesion (2022.08.05). The next day (2022.08.06), he presented with a headache and right shoulder and back pain. The pain continued to worsen, so he came to our hospital (The First Affiliated Hospital of Wannan Medical College) and received a diagnosis of bacterial meningitis, which was confirmed by a lumbar puncture. The patient was treated with appropriate antibiotics, and subsequently recovered before being discharged. Although this complication is relatively rare, its progression is rapid. Meningitis must be suspected when a patient presents with headache, fever, and other symptoms associated with meningitis within days after undergoing radiofrequency treatment for a trigeminal ganglion lesion, especially if the patient has an underlying disease that causes a decline in immunity. We discuss this case in terms of clinical presentation, time of onset, treatment, prognosis, past history, and sex. Although early detection of this complication is beneficial, it is better to effectively prevent its occurrence.
Assuntos
Meningites Bacterianas , Neuralgia do Trigêmeo , Masculino , Humanos , Pessoa de Meia-Idade , Neuralgia do Trigêmeo/terapia , Neuralgia do Trigêmeo/complicações , Gânglio Trigeminal , Streptococcus , Meningites Bacterianas/terapia , Meningites Bacterianas/etiologiaRESUMO
OBJECTIVES: To investigate the incidence, risk factors, and management of meningitis in cochlear implant (CI)users. METHODS: A systematic review was carried out using PubMed, Scopus, Web of Science, and Cochrane Central Register. Articles were considered relevant if reported any data on incidence, clinical presentations, the role of vaccination, management, and outcomes of meningitis after CI. RESULTS: A total of 32 studies including 27358 patients were included, and meningitis was reported in only 202 cases. Meningitis occurred in the period ranging from 1 day to 72 months after CI. A total of 55 patients received the pneumococcal vaccine, while 20 patients received the Haemophilus influenzae type B vaccine. A large number of participants (n=47) had associated anatomical malformations, while 62 had otitis media before meningitis. A total of 24 cases required revision surgery along with medical treatment. Full recovery was the outcome reported by the included studies in 19 patients. CONCLUSION: Cochlear implant users seem to be at possible risk of bacterial meningitis at any time after implantation, especially in the presence of risk factors, such as otitis media and anatomical malformations of the cochlea.
Assuntos
Implante Coclear , Implantes Cocleares , Meningites Bacterianas , Otite Média , Humanos , Implantes Cocleares/efeitos adversos , Implante Coclear/efeitos adversos , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/etiologia , Otite Média/etiologia , Otite Média/microbiologia , VacinaçãoRESUMO
Bacterial meningitis is a rare but severe infectious complication after hematopoietic stem cell transplantation. However, its clinical features were previously not clear. We reviewed the cases of 7 patients diagnosed with bacterial meningitis with a positive cerebrospinal fluid culture among 1147 patients who underwent cord blood transplantation (CBT) at our institution between September 2007 and September 2020. The diagnosis was made on day + 5- + 45, and 5 patients developed bacterial meningitis before neutrophil engraftment. The causative organisms were all Gram-positive cocci: Enterococcus faecium and Enterococcus gallinarum (2 patients each), and Staphylococcus haemolyticus, Streptococcus mitis/oralis, and Rothia mucilaginosa (1 patient each). Six patients developed bacterial meningitis secondary to prior or concomitant bacteremia caused by the same bacterium. Five patients had received anti-MRSA agents at onset: vancomycin in 3, teicoplanin in 1, and daptomycin in 1. After diagnosis of bacterial meningitis, linezolid was eventually used for 6 patients. Two patients with E. gallinarum were alive at day + 1380 and + 157 after CBT, respectively, whereas 5 patients died 17-53 (median 43) days after the onset of bacterial meningitis. Breakthrough meningitis in CBT can occur even during the use of anti-MRSA drugs, and intensive antibiotic treatment is necessary.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Daptomicina , Infecções por Bactérias Gram-Positivas , Meningites Bacterianas , Humanos , Antibacterianos/uso terapêutico , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Daptomicina/uso terapêutico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/etiologia , Meningites Bacterianas/diagnóstico , Testes de Sensibilidade Microbiana , Vancomicina/uso terapêuticoRESUMO
Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.
We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.
Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.
Assuntos
Humanos , Feminino , Recém-Nascido , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae , Gentamicinas/uso terapêutico , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/etiologia , Meningites Bacterianas/tratamento farmacológico , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/tratamento farmacológico , Sepse Neonatal/complicações , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológicoRESUMO
Objectives: Recurrent bacterial meningitis (RBM) is a rare but life-threatening disease. This study aims to analyze the clinical features, potential causes, and therapeutic outcomes of RBM in children. Methods: This article retrospectively reviews the clinical characteristics, etiologies, and treatments in children with RBM hospitalized in Hebei children's hospital from 2012 to 2020. Results: A total of 10 children with RBM, five males and five females, were included in this study. The age of RBM in children spans from the neonatal stage to the childhood stage. The underlying illnesses were identified and classified as cerebrospinal fluid rhinorrhea (1 case), humoral immunodeficiency with Mondini dysplasia (1 case), common cavity deformity with cerebrospinal fluid ear leakage (1 case), Mondini malformations (2 cases), incomplete cochlear separation type I with a vestibular enlargement (2 cases), local inflammation of the sphenoid bone caused by cellulitis (1 case), congenital skull base defects (1 case), and congenital dermal sinus with intraspinal abscess (1 case). 6 patients chose targeted therapy for potential reasons. Conclusions: Congenital abnormalities or acquired injuries lead to intracranial communication with the outside world, which can quickly become a portal for bacterial invasion of the central nervous system, resulting in repeated infections.
Assuntos
Meningites Bacterianas/etiologia , Rinorreia de Líquido Cefalorraquidiano/complicações , Criança , Pré-Escolar , China , Cóclea/anormalidades , Biologia Computacional , Feminino , Humanos , Síndromes de Imunodeficiência/complicações , Lactente , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/diagnóstico por imagem , Meningites Bacterianas/terapia , Meningite Pneumocócica/diagnóstico por imagem , Meningite Pneumocócica/etiologia , Meningite Pneumocócica/terapia , Neuroimagem , Recidiva , Estudos Retrospectivos , Base do Crânio/anormalidades , Espinha Bífida Oculta/complicaçõesRESUMO
Encephalitis and meningitis (EM) are severe infections of the central nervous system associated with high morbidity and mortality. The etiology of EM in Kazakhstan is not clearly defined, so from February 1, 2017 to January 31, 2018 we conducted hospital-based syndromic surveillance for EM at the Shymkent City Hospital, in the South Kazakhstan region. All consenting inpatients meeting a standard case definition were enrolled. Blood and cerebrospinal fluid (CSF) samples were collected for bacterial culture, and CSF samples were additionally tested by PCR for four bacterial species and three viruses using a cascading algorithm. We enrolled 556 patients. Of these, 494 were of viral etiology (including 4 probable rabies cases), 37 were of bacterial etiology, 19 were of unknown etiology and 6 were not tested. The most commonly identified pathogens included enterovirus (73%, n = 406 cases), herpes simplex virus (12.8%, n = 71), and Neisseria meningitidis (3.8%, n = 21). The incidence rates (IRs) for enteroviral and meningococcal EM were found to be 14.5 and 0.7 per 100,000 persons, respectively. The IR for bacterial EM using both PCR and culture results was 3-5 times higher compared to culture-only results. Antibacterial medicines were used to treat 97.2% (480/494) of virus-associated EM. Incorporation of PCR into routine laboratory diagnostics of EM improves diagnosis, pathogen identification, ensures IRs are not underestimated, and can help avoid unnecessary antibacterial treatment.
Assuntos
Encefalite/etiologia , Meningites Bacterianas/etiologia , Meningite Viral/etiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Encefalite/diagnóstico , Enterovirus/isolamento & purificação , Feminino , Hospitais , Humanos , Incidência , Lactente , Cazaquistão/epidemiologia , Masculino , Meningites Bacterianas/diagnóstico , Meningite Viral/diagnóstico , Pessoa de Meia-Idade , Neisseria meningitidis/isolamento & purificação , Simplexvirus/isolamento & purificação , Adulto JovemRESUMO
Dental extractions in horses may result in bacteremia, which can lead to systemic complications. Bacterial meningitis following oral cheek tooth extractions in a 17-year-old Thoroughbred gelding is described in this report. The bacterial meningitis was confirmed by histopathology. The gelding was presented for evaluation of intermittent fever, loose feces, and mild colic signs which started 5 days after cheek tooth extraction. This case illustrates a rare complication associated with oral tooth extraction in a horse and highlights the unusual presenting features of meningitis. Key clinical message: Bacterial meningitis secondary to oral cheek tooth extraction should be considered as differential diagnosis; particularly in cases with the development of pyrexia a few days after the procedure.
Méningite bactérienne après extraction dentaire chez un cheval de 17 ans. Les extractions dentaires chez les chevaux peuvent entraîner une bactériémie, ce qui peut amener des complications systémiques. Un cas de méningite bactérienne à la suite d'extractions buccales de dents jugales chez un hongre pur-sang de 17 ans est décrite dans ce rapport. La méningite bactérienne a été confirmée par histopathologie. Le hongre a été présenté pour évaluation d'une fièvre intermittente, de selles molles et de signes de coliques légers qui ont commencé 5 jours après l'extraction de la dent jugale. Ce cas illustre une complication rare associée à l'extraction dentaire orale chez un cheval et met en évidence des caractéristiques inhabituelles de la méningite.Message clinique clé :La méningite bactérienne secondaire à l'extraction buccale des dents jugales doit être considérée comme un diagnostic différentiel, en particulier dans les cas de développement d'une pyrexie quelques jours après l'intervention.(Traduit par Dr Serge Messier).
Assuntos
Bacteriemia , Doenças dos Cavalos , Meningites Bacterianas , Animais , Bacteriemia/veterinária , Bochecha , Doenças dos Cavalos/etiologia , Cavalos , Masculino , Meningites Bacterianas/etiologia , Meningites Bacterianas/veterinária , Extração Dentária/efeitos adversos , Extração Dentária/veterináriaRESUMO
Bacterial meningitis (BM) is an acute infectious central nervous system (CNS) disease worldwide, occurring with 50% of the survivors left with a long-term serious sequela. Acute bacterial meningitis is more prevalent in resource-poor than resource-rich areas. The pathogenesis of BM involves complex mechanisms that are related to bacterial survival and multiplication in the bloodstream, increased permeability of blood-brain barrier (BBB), oxidative stress, and excessive inflammatory response in CNS. Considering drug-resistant bacteria increases the difficulty of meningitis treatment and the vaccine also has been limited to several serotypes, and the morbidity rate of BM still is very high. With recent development in neurology, there is promising progress for drug supplements of effectively preventing and treating BM. Several in vivo and in vitro studies have elaborated on understanding the significant mechanism of melatonin on BM. Melatonin is mainly secreted in the pineal gland and can cross the BBB. Melatonin and its metabolite have been reported as effective antioxidants and anti-inflammation, which are potentially useful as prevention and treatment therapy of BM. In bacterial meningitis, melatonin can play multiple protection effects in BM through various mechanisms, including immune response, antibacterial ability, the protection of BBB integrity, free radical scavenging, anti-inflammation, signaling pathways, and gut microbiome. This manuscript summarizes the major neuroprotective mechanisms of melatonin and explores the potential prevention and treatment approaches aimed at reducing morbidity and alleviating nerve injury of BM.
Assuntos
Melatonina/farmacologia , Meningites Bacterianas/prevenção & controle , Antibacterianos/farmacologia , Disponibilidade Biológica , Barreira Hematoencefálica/efeitos dos fármacos , Citocinas/metabolismo , Humanos , Metaloproteinases da Matriz/metabolismo , Melatonina/química , Melatonina/metabolismo , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/etiologia , Estresse Oxidativo/efeitos dos fármacosRESUMO
Bacterial meningitis is a neurological emergency with high morbidity and mortality. We herein investigated clinical features, etiology, antimicrobial susceptibility profiles, and prognosis of bacterial meningitis in adults from a single tertiary center. We retrospectively reviewed medical records of patients with laboratory-confirmed bacterial meningitis from 2007 to 2016. Patients with recent neurosurgery, head trauma, or indwelling neurosurgical devices were classified as having healthcare-related meningitis. Causative microorganisms were identified by analyzing cerebrospinal fluid (CSF) and blood cultures, and antimicrobial susceptibility profiles were evaluated. We performed multiple logistic regression analysis to identify factors associated with unfavorable outcomes. We identified 161 cases (age, 55.9 ± 15.5 years; male, 50.9%), of which 43 had community-acquired and 118 had healthcare-related meningitis. CSF and blood culture positivity rates were 91.3% and 30.4%, respectively. In community-acquired meningitis patients, Klebsiella pneumoniae (25.6%) was the most common isolate, followed by Streptococcus pneumoniae (18.6%) and Listeria monocytogenes (11.6%). The susceptibility rates of K. pneumoniae to ceftriaxone, cefepime, and meropenem were 85.7%, 81.3%, and 100%, respectively. Among healthcare-related meningitis patients, the most common bacterial isolates were coagulase-negative staphylococci (28.0%), followed by Staphylococcus aureus (16.1%) and Enterobacter spp. (13.6%). Neurological complications occurred in 39.1% of the patients and the 3-month mortality rate was 14.8%. After adjusting for covariates, unfavorable outcome was significantly associated with old age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.06), neurological complications (OR 4.53, 95% CI 1.57-13.05), and initial Glasgow coma scale ≤ 8 (OR 19.71, 95% CI 4.35-89.40). Understanding bacterial pathogens and their antibiotic susceptibility may help optimize antimicrobial therapy in adult bacterial meningitis.
Assuntos
Bactérias , Técnicas de Tipagem Bacteriana , Meningites Bacterianas , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Meningites Bacterianas/etiologia , Meningites Bacterianas/microbiologia , Meningites Bacterianas/mortalidade , Meningites Bacterianas/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A 47-year-old man who was previously hospitalized three times due to bacterial meningitis experienced a headache and posterior neck pain in May. He was admitted to our hospital because of a fever 3 h later. He was fully conscious and febrile, with a headache and signs of meningeal irritation. A cerebrospinal fluid examination showed an increased number of cells with polynuclear cell predominance and decreased glucose levels, leading to the diagnosis of bacterial meningitis. Steroid and antibiotic treatment was initiated, at which time, large amounts of nasal discharge were observed. Cisternal scintigraphy was performed, and cerebrospinal fluid was detected in the nasal discharge. The cause was idiopathic, and endoscopic repair was performed. The nasal fluid leakage was suggested to be the cause of the recurrent bacterial meningitis in this case.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/complicações , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/etiologia , Antibacterianos/administração & dosagem , Biomarcadores/líquido cefalorraquidiano , Líquido Cefalorraquidiano/citologia , Líquido Cefalorraquidiano/metabolismo , Rinorreia de Líquido Cefalorraquidiano/terapia , Dexametasona/administração & dosagem , Quimioterapia Combinada , Endoscopia , Glucose/líquido cefalorraquidiano , Humanos , Masculino , Meningites Bacterianas/tratamento farmacológico , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Neutrófilos , Cintilografia , Recidiva , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Due to heightened awareness and advanced genetic tools, inborn errors of immunity (IEI) are increasingly recognized in children. However, diagnosing of IEI in premature infants is challenging and, subsequently, reports of IEI in premature infants remain rare. This review focuses on how common disorders of prematurity, such as sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia, can clinically overlap with presenting signs of IEI. We present four recent cases from a single neonatal intensive care unit that highlight diagnostic dilemmas facing neonatologists and clinical immunologists when considering IEI in preterm infants. Finally, we present a conceptual framework for when to consider IEI in premature infants and a guide to initial workup of premature infants suspected of having IEI.
Assuntos
Diagnóstico Tardio , Síndromes de Imunodeficiência/diagnóstico , Doenças do Prematuro/diagnóstico , Infecções/etiologia , Infecções Bacterianas/etiologia , Displasia Broncopulmonar/complicações , Candida parapsilosis , Candidíase Invasiva/complicações , Criança , Diagnóstico Diferencial , Enterocolite Necrosante/complicações , Evolução Fatal , Feminino , Estudos de Associação Genética , Humanos , Síndromes de Imunodeficiência/complicações , Síndromes de Imunodeficiência/genética , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/genética , Inflamação , Unidades de Terapia Intensiva Neonatal , Linfo-Histiocitose Hemofagocítica/diagnóstico , Masculino , Meningites Bacterianas/etiologia , Recidiva , Sepse/etiologiaRESUMO
In Japan, pneumococcal vaccine has been routinely administered since 2010 to prevent invasive pneumococcal diseases such as Streptococcus pneumoniae meningitis. We describe a case of pneumococcal meningitis in a 7-month-old girl who had received three doses of 13-valent pneumococcal conjugate vaccine. Brain magnetic resonance imaging showed infarcts in the right frontal region, and she was treated with antibiotics, intravenous immunoglobulin, dexamethasone, and edaravone. On day 27, an enhanced brain CT scan showed improvement of abnormal findings in the frontal region, except for slight atrophy. The S. pneumoniae serotype was 12F, which is not included in the 13-valent pneumococcal conjugate vaccine. A future vaccine is expected to use cross-reactivity to target common antigens.
Assuntos
Meningites Bacterianas/etiologia , Meningites Bacterianas/microbiologia , Infecções Pneumocócicas , Vacinas Pneumocócicas/efeitos adversos , Streptococcus pneumoniae , Vacinas Conjugadas/efeitos adversos , Antígenos de Bactérias/imunologia , Encéfalo/diagnóstico por imagem , Reações Cruzadas , Dexametasona/uso terapêutico , Edaravone/uso terapêutico , Feminino , Humanos , Imunoglobulinas Intravenosas , Lactente , Imageamento por Ressonância Magnética , Meningites Bacterianas/diagnóstico por imagem , Meningites Bacterianas/tratamento farmacológico , Infecções Pneumocócicas/prevenção & controle , Sorogrupo , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/imunologia , Tomografia Computadorizada por Raios XRESUMO
Stress-induced changes in pharmacokinetics can significantly alter the plasma levels of some drugs such as clozapine. This report describes the case of a middle-aged man with schizoaffective disorder, bipolar type who showed sustained elevation in clozapine levels 3 days after discontinuation. Before the clozapine levels were drawn, he had developed acute bacterial pneumonia and signs of acute bacterial meningitis followed by neuroleptic malignant syndrome after he received multiple doses of intravenous haloperidol for worsening psychosis and aggressive behavior. Existing literature on this topic is also reviewed to investigate potential reasons for sustained clozapine levels during acute inflammatory stress and neuroleptic malignant syndrome.
Assuntos
Antipsicóticos/sangue , Clozapina/sangue , Meningites Bacterianas/etiologia , Síndrome Maligna Neuroléptica/etiologia , Pneumonia Bacteriana/etiologia , Transtornos Psicóticos/tratamento farmacológico , Doença Aguda , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report our experience caring for an infant with respiratory syncytial virus infection (RSV) and group B Streptococcus (GBS) bacteremia and meningitis. Concurrent GBS meningitis and RSV is rare but highlights the importance of correlating clinical symptoms with viral diagnostic testing during the evaluation of infants at risk for serious bacterial infection.
Assuntos
Meningites Bacterianas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Coinfecção , Diagnóstico Tardio , Feminino , Humanos , Recém-Nascido , Meningites Bacterianas/etiologia , Meningites Bacterianas/microbiologia , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/complicações , Streptococcus agalactiae/isolamento & purificaçãoRESUMO
Cochleocele is an extrusion or herniation of the endosteum, through an incomplete stapes footplate, into the middle ear. The cochleocele may rupture resulting in a cerebrospinal fluid leak into the middle ear space causing a risk of menigitis. We report six cases of Incomplete Partition Type I with cochleocele which have all been successfully treated using a Totally Endoscopic Ear Surgery approach even during infancy. As the first two cases developed post-operative pseudomonas meningitis, preventative strategies are recommended.
Assuntos
Orelha Média/cirurgia , Endoscopia , Herniorrafia/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Estribo/anormalidades , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Criança , Pré-Escolar , Orelha Média/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Meningites Bacterianas/etiologia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Complicações Pós-Operatórias , Infecções por Pseudomonas/etiologiaRESUMO
Spinal adhesive arachnoiditis (SAA) with cyst formation secondary to infectious meningitis is a rare clinical entity. These cysts can compress the spinal cord and cause neurologic decline. We present a case of a patient who underwent resection for an intradural schwannoma which was complicated post-operatively by bacterial meningitis and development of several recurrent thoracic arachnoid cysts. After two separate thoracic decompressions with lysis of intradural adhesions, a permanent ventriculoperitoneal shunt (VPS) was eventually placed with complete recovery of his symptoms. Our review of the literature showed that CSF shunts have previously been successfully used to treat spinal fluid collections. Although there are many factors to consider when treating these patients, CSF diversion may be beneficial for similar SAA presentations in order to simultaneously treat and prevent recurrence of symptoms.
Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/cirurgia , Aracnoidite/congênito , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Derivação Ventriculoperitoneal/métodos , Cistos Aracnóideos/diagnóstico por imagem , Aracnoidite/diagnóstico por imagem , Aracnoidite/etiologia , Aracnoidite/cirurgia , Descompressão Cirúrgica , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/etiologia , Meningites Bacterianas/terapia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Recuperação de Função Fisiológica , Recidiva , Doenças da Coluna Vertebral/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history. CASE PRESENTATION: The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone. CONCLUSIONS: Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.