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Objective To evaluate the efficacy and safety of tigecycline combined with cefoperazone-sulbactam sodium in the treatment of multi-/extensively-drug resistant Acinetobacter baumannii(MDRAB/XDRAB)associated central nervous system(CNS)infection,and to provide clinical evidence for antibiotic treatment of MDRAB/XDRAB-related intracranial disease.Methods The Wanfang Data Knowledge Service Platform,Chinese Biomedical Literature Database,VIP Chinese Science and Technology Journal Full-text Database,China National Knowledge Infrastructure(CNKI),Pubmed,Embase database,and Cochrane Library were searched to extract the literature of randomized controlled studies on tigecycline and cefoperazone sulbactam in the treatment of MDRAB/XDRAB CNS infection until September 1st,2022.The included studies were assessed for quality using the Cochrane Collaboration Risk of Bias assessment tool,and valid data were extracted and meta-analyzed using RevMan5.4 software.Results A total of 184 articles were screened and 4 Chinese RCTs were finally included,with a sample size of 267 cases.Meta-analysis showed that the overall efficacy of combination therapy for MDRAB/XDRAB CNS infection was better than monotherapy[OR = 4.30,95%CI =(1.93,9.58),P＜0.01].Combination therapy had a better bacterial clearance[OR=4.20,95%CI=(2.08,8.48),P＜0.01].And combination therapy resulted in a lower incidence of adverse effects[OR= 0.19,95%CI =(0.05,0.67),P＜0.05].There was no apparent difference in cure rate between combination therapy and monotherapy(P＞0.05).Conclusion Current evidence suggests that tigecycline combined with cefoperazone-sulbactam sodium may have better clinical efficacy and safety than monotherapy for MDRAB/XDRAB CNS infections.Limited by the number and quality of included studies,needs to be verified by more and higher-quality studies.
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Objective:To investigate the clinical characteristics of non-perinatal adult patients with Listeria monocytogenes (LM) infection. Methods:Twenty-five non-perinatal adult patients who were etiologically confirmed as listeriosis in Tangdu Hospital, Fourth Military Medical University during January 2010 and July 2023 were enrolled in this study. The characteristics of demographic data, underlying diseases, clinical manifestations, laboratory indicators, cranial imaging examination, anti-microbial therapeutic schemes and clinical outcomes were retrospectively analyzed. The clinical characteristics were compared between patients with Listeria septicemia and Listerial meningoencephalitis, as well as between survival and death patients. Independent samples t test and Mann-Whitney U test were used for statistical analysis. Results:The age of enrolled patients was (52.84±12.17) years. Eighteen patients were male, and seven patients were female. The major clinical manifestations included fever (23/25(92%)), headache (15/25 (60%)), disorder of consciousness (12/25(48%)) and vomiting (8/25(32%)). Thirteen (52%) patients had underlying diseases (including hematological diseases, autoimmune disorders, solid neoplasms, and liver cirrhosis, etc). There were no significant differences in blood routine test, aminotransferase, protein levels, renal function, electrolyte, blood glucose, and inflammatory indicators between patients with Listeria septicemia and Listerial meningoencephalitis (all P>0.05). The platelet count in the death group was significantly higher than that in the recovery group ((243.10±92.96)×10 9/L vs (157.80±75.55)×10 9/L, t=2.45, P=0.022). There were also no significant differences in blood biochemical index and inflammatory indicators between these two groups (all P>0.05). Cranial imaging examination of patients with Listerial meningoencephalitis manifested as intracranial infection, cerebral edema/hydrocephalus or cerebral hernia. All nineteen patients with Listerial meningoencephalitis had elevated cerebrospinal fluid (CSF) pressure (220.0(130.0, 290.0) mmH 2O (1 mmH 2O=0.009 8 kPa)), elevated CSF total cell count (522.0(350.0, 783.0)×10 6/L), elevated CSF white blood cell count (356.0(266.0, 668.0)×10 6/L), and CSF protein level (1 817.0(822.5, 6 000.0) mg/L). Fifteen patients had reduced CSF chloride level ((111.70±8.51) mmol/L). Ten patients had decreased CSF glucose level (3.71(1.45, 7.11) mmol/L). The drug sensitivity results of blood and CSF cultures revealed that LM was sensitive to ampicillin. One case was resistance to penicillin, three cases were resistance to meropenem, while three cases were resistance to trimethoprim-sulfonamide. Thirteen cases out of seventeen recovery patients were administered with ampicillin or penicillin-based therapy. Conclusions:When patients with underlying diseases or immune dysfunction suffered with clinical symptoms such as high fever, central nervous system infection, they should be alert to the possibility of listeriosis. Early administration of ampicillin-based therapeutic strategy is beneficial for clinical recovery of the patients.
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Tuberculous meningitis is a central nervous system infectious disease caused by Mycobacterium tuberculosis. Its clinical manifestations are nonspecific, and effective pathogenic diagnostic methods are lacking, which often lead to delayed diagnosis and treatment, impacting the prognosis of patients. Therefore, early and rapid etiological diagnosis is crucial for the diagnosis and treatment of tuberculous meningitis. This article provides a review of novel detection technologies developed in recent years that can be used for the diagnosis of tuberculous meningitis, covering nucleic acid detection methods, metabolomics, and proteomics, and offering prospects for future development.
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Objective:To analyze the clinical features and etiological results of neonatal central nervous system(CNS) infection and provide basis for optimization of pathogen detection strategy for CNS infection.Methods:We collected the clinical and laboratory data of hospitalized neonates with clinical diagnosis of CNS infection in the neonatal department at Hebei Provincial Children′s Hospital, from January 1, 2020 to August 31, 2021.The clinical manifestations of the enrolled neonates, as well as the cerebrospinal fluid(CSF)pathogens detected by conventional and molecular biological detection techniques were analyzed.Laboratory characteristics of different kinds of pathogen were compared.Results:A total of 101 eligible neonates were enrolled.The median gestational age was 38.8(36.2, 39.6)weeks, with a prematurity rate 26.7%.There were 68 boys.The median age of onset was 9(2, 14)days.Blood culture was positive in 19(18.8%) cases, including 17 cases of bacteria and two cases of fungus.Positive findings were found in CSF specimens of 33(32.7%)cases by various methods including 13 bacteria, 19 viruses and one fungi.Streptococcus group B and Escherichia coli were the first two bacteria in CSF.Enterovirus was the most common virus in CSF.In terms of detection methods of CSF pathogens, seven cases(7/101, 6.9%) were detected by CSF culture, two cases(2/21, 9.5%)by smear, 22 cases(22/45, 48.9%)by single-virus targeted/multiplex polymerase chain reaction and four cases(4/7, 57.1%)by metagenomic next-generation sequencing.The CSF white blood cell counts, protein levels and blood C-reactive protein levels were higher in the cases with bacteria/fungi detection from CNS infection than in those with virus detection( P<0.05). Almost all neonates(98/101, 97.0%)were clinically cured or significantly improved before discharge.Two neonates were discharged against medical advice and one neonate was transferred to the other hospital after clinical improvement. Conclusion:Combined use of conventional and molecular biological detection techniques can significantly improve the etiological positive rate of neonatal CNS infection.Viral infection is not rare in the neonatal population.Our study demonstrated the spectrum of organism causing neonatal CNS infection, which provided a basis for the optimization of pathogen detection strategy.
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Objective:To investigate the etiological diagnostic value of metagenomic sequencing in central nervous system (CNS) infectious diseases.Methods:A total of 170 patients with central nervous system infection admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2020 were selected as the study subjects according to inclusion and exclusion criteria. General clinical data and pathogen test results were collected. All included patients underwent routine examination and mNGS test, and were divided into the conventional method test group and mNGS test group according to the test results. The measurement data conforming to normal distribution were represented by ± s; The measurement data that did not conform to normal distribution were represented by median and interquartile range. The classification data were expressed by the number of cases and percentage( n,%), and were compared by χ2 test or Fisher's exact test. Consistency test was represented by Kappa value. The detection of pathogenic microorganisms by the two methods and the rule of pathogen spectrum were compared and analyzed. Results:The overall positive rate of mNGS in CNS infectious diseases was higher than that of conventional methods (58.23% vs. 18.82%), and the difference was statistically significant ( P<0.01). Among the 20 samples which were both positive by the two methods, 10 cases were completely pathogenic, 5 cases were partially consistent and 5 cases were completely inconsistent. In the detection of tuberculous nervous system infection, the positive rates were 66.7%, 53.8%, 44.0%, 40.0%, 4.0% in blood T-SPOT, cerebrospinal fluid mNGS, ADA, Mycobacterium tuberculosis DNA and tuberculous specific antibody, respectively. The positive rate of acid-fast staining was 0. The positive rate of mNGS combined with conventional method was 80.8%. Conclusions:The detection rate of mNGS in CNS infection is better than that of conventional methods. However, it does not show obvious superiority in the detection rate of Mycobacterium tuberculosis associated nervous system infection. In general, mNGS detection of pathogenic bacteria is more extensive, which is conducive to a thorough and comprehensive understanding of the bacterial characteristics of central nervous system infection. The combination of the two methods can make up for the deficiency of clinical routine detection to a certain extent, and can maximize the detection rate.
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Objective:To investigate the value of metagenomic next-generation sequencing (mNGS) in central nervous system infection (CNSI) of critically ill patients from Neurosurgery.Methods:A prospective study was conducted. From October 2019 to April 2021, 52 patients with highly suspected CNSI in the Department of Neurosurgical Intensive Care Unit (NICU) of our hospital were chosen. The collected cerebrospinal fluid (CSF) samples were simultaneously performed mNGS and traditional culture; the clinical diagnosis of CNSI was taken as the standard, and the sensitivity, specificity, positive predictive value, negative predictive value, and time from sample collection to result feedback of these two methods were compared. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic values of mNGS and traditional culture in CNSI.Results:Eventually, 25 patients with CNSI were clinically confirmed; 23 were with positive mNGS, including 16 with bacterial infection, 4 with viral infection, 1 with fungal infection, and 2 with mixed infection (1 with bacteria+virus+fungus, 1 with bacteria+virus); 8 were with positive traditional culture, all of which were bacterial infections. The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 92.0%, 85.2%, 85.2%, and 92.0%, respectively; those of traditional culture were 32.0%, 100.0%, 100.0%, and 61.4%, respectively; the time from sample collection to result feedback of mNGS and traditional culture was (31.77±5.23) h and (101.83±9.15) h, respectively, with significant difference ( P<0.05). ROC curve showed that the area under the curve (AUC) of mNGS for diagnosis of CNSI was 0.886 ( 95%CI: 0.786-0.986, P<0.001); the AUC of traditional culture for diagnosis of CNSI was 0.660 ( 95%CI: 0.508-0.812, P=0.002). Conclusion:For patients with CNSI from NICU, mNGS has good diagnostic efficacy and application value and can effectively compensate for the lack of traditional cerebrospinal fluid culture.
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RESUMEN Introducción: El empiema subdural es una afección infrecuente, caracterizada por la presencia de material purulento entre la duramadre y la aracnoides. Representa entre el 15-20 % de las infecciones intracraneales, con una mortalidad de un 10 %. Objetivo: Presentar un paciente con diagnóstico de empiema subdural. Caso clínico: Paciente masculino de 22 años, con síntomas de infección respiratoria alta, fiebre de 39 °C, cefalea, toma del estado general y dificultad para movilizar el miembro inferior derecho; que la evaluación inicial sugiere diagnóstico de meningoencefalitis bacteriana y tuvo evolución desfavorable, se identifica con los estudios imagenológicos, la presencia de un empiema subdural secundario a una sinusitis polipoidea. Conclusiones: El empiema subdural es una entidad poco frecuente, con elevada mortalidad si no se realiza un diagnóstico y tratamiento precoz. Dentro de las infecciones del sistema nervioso central siempre se debe tener en cuenta, pues requiere un alto índice de sospecha clínica y el uso adecuado de las imágenes para su diagnóstico.
ABSTRACT Introduction: Subdural empyema is a rare condition, characterized by the presence of purulent material between the dura mater and the arachnoid mater. It represents between 15-20 % of intracranial infections, with a mortality of 10 %. Objective: To present a patient with a diagnosis of subdural empyema. Clinical case: A 22-year-old male patient, with symptoms of upper respiratory infection, fever of 39 °C, headache, poor general condition and difficulty in mobilizing the right lower limb; whose initial evaluation suggests a diagnosis of bacterial meningoencephalitis and had an unfavorable evolution, being identified after imaging studies the presence of a subdural empyema secondary to polypoid sinusitis. Conclusions: Subdural empyema is a rare entity, with high mortality if early diagnosis and treatment are not performed. Within infections of the central nervous system, it should always be taken into account, since it requires a high index of clinical suspicion and the adequate use of images for its diagnosis.
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A pesar de los avances en las técnicas de diagnóstico y tratamiento, las infecciones intracraneanas son aún enfermedades graves con una incidencia estimada entre 0,3 y 1,3 casos por cada 100 000 habitantes. Se presenta un paciente previamente sano con un absceso cerebral de diagnóstico intraoperatorio en quien, si bien el cultivo evidenció desarrollo polimicrobiano, se identificó presuntivamente Actinomyces sp. en la anatomía patológica. Dado este hallazgo, se realizó antibioticoterapia combinada prolongada con buena evolución. La presentación de este proceso supurado fue inespecífica y la contribución de la anatomía patológica en el diagnóstico etiológico fue relevante. La identificación de un microorganismo inhabitual definió la necesidad de profundizar en la determinación de factores predisponentes
Despite advances in diagnostic and treatment techniques, intracranial infections remain serious diseases with an estimated incidence of between 0.3 and 1.3 cases/100,000 inhabitants. We present a previously healthy patient with an intraoperative diagnostic of brain abscess, in whom although the culture showed polymicrobial development, Actinomyces sp was presumptively identified in the pathological anatomy. Given this finding, prolonged combined antibiotic therapy was performed with good evolution The presentation of this suppurative process was nonspecific and the contribution of the anatomopathology in the etiological diagnosis was relevant. The identification of an unusual microorganism defined the need to deepen the identification of predisposing factors.
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Humains , Mâle , Enfant , Abcès cérébral/diagnostic , Actinomyces , Antibactériens/usage thérapeutiqueRÉSUMÉ
ABSTRACT Neurotoxocariasis is uncommon. Its manifestations include events of meningitis, encephalitis and less frequently vasculitis, which manifest as headache, seizures, focalization, confusion, cognitive alterations and /or fever. Peripheral eosinophilia with clinical and neurological imaging elements, allow its early suspicion. We report a 48-year-old agricultural worker, admitted in our hospital for one week of gastrointestinal complaints, headache, progressive left hemiparesis and impaired consciousness. He had leukocytosis (13,530/μL) with peripheral eosinophilia (25%, absolute count 3,400 /μL). CSF analysis revealed no abnormalities and brain CT showed poorly defined hypodense lesions on subcortical areas and semioval centers. Magnetic resonance imaging showed multiple foci with increased signals predominantly in the white matter in both hemispheres, especially at frontal and occipital regions and at semioval centers. Lesions reinforced after paramagnetic contrast. Serological studies found specific IgG antibodies by ELISA against antigens of the genus Toxocara, which were confirmed by a positive IgG Western Blot. The patient was treated with albendazole (800 mg/d) for 14 days associated with parenteral and then oral corticosteroids with a favorable response and gradual complete recovery.
La neurotoxocariasis es infrecuente. Sus manifestaciones incluyen eventos de meningitis, encefalitis y con menor frecuencia vasculitis, que se manifiestan como cefalea, convulsiones, focalización, confusión, alteraciones cognitivas o fiebre. La eosinofilia periférica, junto a elementos clínicos e imágenes compatibles, permiten su sospecha. Informamos el caso de un trabajador agrícola de 48 años que ingresó por una semana de molestias gastrointestinales, cefalea, hemiparesia izquierda progresiva y deterioro de conciencia. Los exámenes revelaron leucocitosis (13.530/μL) con eosinofilia periférica (25%, recuento absoluto 3.400/μL). El análisis del LCR sin anomalías y la tomografía computada cerebral mostró lesiones hipodensas mal definidas en áreas subcorticales y centros semiovales. La resonancia magnética mostró múltiples focos con aumento de la señal predominantemente en la sustancia blanca en ambos hemisferios. Las lesiones presentaron refuerzo tras contraste paramagnético. Los estudios serológicos indicaron anticuerpos IgG específicos por ELISA contra antígenos del género Toxocara. El paciente fue tratado con albendazol (800 mg /día) durante 14 días asociado a corticoides con respuesta favorable y una recuperación gradual completa.
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Humains , Mâle , Adulte d'âge moyen , Imagerie par résonance magnétique , Éosinophilie/diagnostic , Éosinophilie/imagerie diagnostique , Crises épileptiques , Encéphale/imagerie diagnostique , Immunoglobuline G , CéphaléeRÉSUMÉ
Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.
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Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which Naegleria fowleri followed by Acanthamoeba spp. and Balamuthia mandrillaris have been successively discovered. As the three dominant genera responsible for infections, Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.
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Enfant , Humains , Amibiase/épidémiologie , Balamuthia mandrillaris , Encéphale , Protozooses du système nerveux central/épidémiologie , Naegleria fowleriRÉSUMÉ
Objective To evaluate the role of multi-disciplinary team (MDT) in improving the diagnosis and treatment of human herpes virus-6B (HHV-6B) encephalitis after liver transplantation. Methods MDT consultation was delivered for one rare case of HHV-6B encephalitis after liver transplantation to establish an effective individualized treatment regime. Results On the 16 d after liver transplantation, the patient developed headache, and suddenly presented with unresponsiveness, unconsciousness, coma complicated with involuntary limb twitching on the 18 d. Blood ammonia level was increased. Brain CT scan showed cerebral ischemic changes. Electroencephalography prompted the epileptic seizure. After MDT consultation, the possibility of nervous system infection after liver transplantation was considered, and medication therapy was given to control the epileptic seizure. Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure. Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6B nucleic acid, which confirmed the diagnosis of HHV-6B encephalitis. The immunosuppressant regime was adjusted, intravenous ganciclovir was given for antiviral treatment, and active interventions were delivered to prevent and treat relevant complications. Epileptic seizure disappeared after 4 d, and neurological symptoms were significantly alleviated after 2 weeks. After 4-week antiviral treatment, the patient was tested negative for virology testing, and the neurological function was restored to normal. Conclusions HHV-6B encephalitis rarely occurs after adult liver transplantation, which is primarily associated with the virus reactivation after use of immunosuppressant. MDT pattern may be employed to deepen the understanding of the patient's condition, formulate more effective individualized treatment regime, and enhance the clinical efficacy and safety.
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Objective:To clarify the risk factors for post-operative central nervous system infection (PCNSI) to provide references for prevention and treatment of PCNSI.Methods:A total of 397 patients with neurosurgery diseases, admitted to and accepted 403 surgeries in our hospital from February 1 st, 2015 to December 30 th, 2015, were chosen in our study; their clinical data were collected. The incidence of PCNSI was analyzed. Risk factors for PCNSI were analyzed by univariate analysis and multivariate Logistic regression analysis. The ajusted specific infection rate of PCNSI was calculated in 12 chief surgeons who performed≥8 operations during the study period to assess the influence of surgeons in PCNSI incidence. Results:The PCNSI incidence in these 397 patients was 9.2% (37/403). The cerebrospinal fluid (CSF) culture positive rate was 29.7% (11/37), including 6 (54.6%) with positive gram staining. Univariate analysis showed that as compared with the non-infected group (366 surgeries), patients in the PCSNI group (37 surgeries) had significantly higher National Nosocomial Infections Surveillance (NNIS) scale, significantly higher proportion of patients with preoperative stay>6 d, significantly longer operative duration, and statistically higher proportion of involvement of scrub nurses with experience in fewer than 8 procedures ( P<0.05). Multivariate Logistic regression analysis showed operative duration ( OR=1.389, 95%CI: 1.202-1.606, P=0.000) and involvement of scrub nurses with experience in fewer than 8 procedures ( OR=2.860, 95%CI: 1.276-6.412, P=0.011) were independent risk factors for PCNSI. After adjustment by NNIS scale, the ajusted specific infection rate of PCNSI in 12 chief surgeons was 20.0%, 23.0%, 17.3%, 18.2%, 13.4%, 12.5%, 6.3%, 8.0%, 5.2%, 4.0%, 0.0%, and 0.0%, respectively, enjoying obvious differences. Conclusion:Specialized infection control training should give to surgeons with high adjusted specific infection rate of PCNSI; this training, shortening operative duration, and training of neurosurgery specialist nurses will be important measures to reduce PCNSI incidence.
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Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.
Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning Ìs groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.
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Humains , Hydrocéphalie , Hémorragie meningée , Ventriculostomie , Système nerveux central , Infections du système nerveux centralRÉSUMÉ
OBJECTIVE：To investigate the r ole of clinical pharmacists on the therapy for human herpesvirus 7（HHV-7） infection in central nervous system. METHODS ：The clinical pharmacists participated in the treatment process of the hospitalized patient who was a 15-year-old patient with central nervous system infection. The doctor initially gave Levetiracetam tablets （500 mg，bid，po）to control epilepsy symptoms ，and Acyclovir for injection （500 mg，q8 h，ivgtt）for antiviral treatment. According to the large red wheal scattered rubella on the limbs and back of the patient ，clinical pharmacists recommended to give Dexamethasone sodium phosphate injection （10 mg，qd，iv）and Loratadine tablets （10 mg，qd，po）for anti-allergy treatment ；in view of involuntary shaking of limbs in the patient ，clinical pharmacists recommended to continue to give Dexamethasone sodium phosphate injection intravenously to control inflammation and Xingnaojing injection （20 mL，qd，ivgtt） to improve the convulsion. For HHV- 7 infection，based on consulting the relevant guidelines and existing treatment experience ，the clinical pharmacists recommended discontinuation of acyclovir ， dexamethasone combined with Human immunoglobulin （pH 0278）（17.5 g，qd，ivgtt）for impact therapy should be used and adverse drug reactions and therapeutic effects should be monitored at the same time. RESULTS ： The physiciansaccepted the suggestions of clinical pharmacists. The patient was improved and discharged from the hospital after 18 days of treatment. CONCLUSIONS ： During the treatment of ineffective case of clinic rare central nervous system infectious diseases with routine a ntiviral drugs ，clinical pharmacists assisted physicians to improve their treatment plan and ensure the effectiveness and safety of patient ’s medication.
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Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in B.J medical college. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male: female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of < 7 day (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.
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Background: CNS infections have been linked to adverse neurological sequelae notably seizures and mortality. Although, various etiologies of AFE have been studied, but the mystery still remains untangled for the substantial risk factors for the diagnosis and outcome.Methods: This prospective study was carried out on 67 children between 2 months to 15 years, from (May 2016 to April 2017) tertiary care centre of Uttarakhand. Patients were analysed for demographic variables, haematological parameters, CSF analysis, neuroimaging and their outcome was assessed at one month of follow up.Results: This study showed, 70% (n=47) of the cases presented in acute febrile encephalopathy. Most cases were diagnosed with pyogenic meningitis (40%, n=27) and More commonly occur during rainy season (39%; n=26) radiologically meningeal enhancement (28%; n=18) as the most common finding. Cases of acute febrile encephalopathy with GCS ?5 had significant association with mortality. (Fischer exact value of 0.005; significant at p<0.05).Conclusions: Clinical signs of meningitis are not always reliable, and a laboratory support is required to reach early diagnosis hence. Pseudomonas and MRCONS were the major pathogens responsible for the bacterial meningitis among the paediatric age groups, hence antibiotic management should be planned intensively while culture reports are awaited. Cluster of cases with meningoencephalitis were found in rainy season hence suggested possible etiologies are JE/ Scrub/ Enterovirus. Mortality as well as morbidity was high in cases with acute encephalitis syndrome cause? JE/unknown etiology in this era for modern medicine hence vector control strategies be encouraged.
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Background: Scrub typhus is an emerging epidemic in India. Its course can be complicated by involvement of Respiratory system, cardiovascular system, gastrointestinal system and central nervous system. Central nervous system involvement can lead to major morbidity and mortality.Methods: It is an observational study conducted in the Department of Pediatrics, Patna Medical College and Hospital, Patna from January 2016 to August 2018.' All cases of AES who were serologically proven to be due to scrub typhus were clinically examined, signs and symptoms were noted, and complete blood counts were done. Lumbar puncture was done, and CSF was sent for analysis of cells, sugar and protein, IgM for scrub typhus in CSF, gram staining and CSF culture.Results: Seventy-eight cases were tested positive for scrub typhus. Incidence of scrub typhus among AES cases was 19.4% in the study. Among cases of Scrub typhus, a male predominance and sex ratio was 1.68. Age at presentation ranged from 2 months to 12 years with a mean age of 7.28 years. Most of the cases were seen in the months of September and October with a mini peak in the month of March. Fever and Altered consciousness were present in all the cases. Among laboratory investigations, thrombocytopenia was the most common feature followed by raised Transaminases. CSF Analysis shows mildly increased cell count with lymphocytic predominance and presence of few polymorphs, sugar mildly decreased, and protein mildly raised.Conclusions: Scrub typhus is an important causative agent of AES in the Eastern parts of India. It should be suspected in cases which present as AES with symptoms of hepatosplenomegaly, thrombocytopenia, and elevated liver enzymes in addition to dengue encephalitis which forms its close differential.
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Patients with central nervous system infection are always accompanied by severe long－term seque﹣lae and high mortality and disability,so timely diagnosis and treatment are required. Recognition of pathogens often plays a key role in treating such disease. This article reviewed new research progress in the differential diagnosis of different pathogens of central nervous system infection,which may provide the basis for the etiological and differential diagnosis of it.
RÉSUMÉ
Patients with central nervous system infection are always accompanied by severe long-term seque-lae and high mortality and disability, so timely diagnosis and treatment are required.Recognition of pathogens often plays a key role in treating such disease.This article reviewed new research progress in the differential diagnosis of different pathogens of central nervous system infection, which may provide the basis for the etiological and differential diagnosis of it.