Accuracy of cerebrospinal fluid ferritin for purulent meningitis.

OBJECTIVE: To evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM). METHOD: We studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis). RESULTS: The median age was 24 (IQR 8-69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0-6.5), 52.9 ng/mL (IQR 30.7-103 ng/mL) and 2.4 ng/mL (IQR 2-4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis. CONCLUSION: CSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.

Mycoplasma pneumoniae: manifestaciones neurológicas y controversias diagnósticas. A propósito de un caso / Mycoplasma pneumoniae: neurologic manifestations and diagnostic controversies. A case report

Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.

Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.

[Mycoplasma pneumoniae: neurologic manifestations and diagnostic controversies. A case report]. / Mycoplasma pneumoniae: manifestaciones neurológicas y controversias diagnósticas. A propósito de un caso.

Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.

Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.

Aseptic meningitis caused by Leptospira spp diagnosed by polymerase chain reaction.

Leptospirosis is a zoonotic disease caused by the pathogenic Leptospira spp. The clinical presentations are diverse, ranging from undifferentiated fever to fulminant disease including meningeal forms. The neurological leptospirosis forms are usually neglected. The aim of this study was to investigate leptospirosis as the cause of aseptic meningitis using different diagnostic techniques including the polymerase chain reaction (PCR). Thirty-nine cerebrospinal fluid (CSF) samples from patients presenting with meningeal abnormalities, predominance of lymphocytes and negative results by traditional microbiological tests were processed by leptospiral culture, anti-leptospiral antibody response and PCR. Leptospira spp DNA was detected in 23 (58.97%) of the CSF samples. Anti-leptospiral antibodies were found in 13 (33.33%) CSF samples. Twelve CSF samples were positive by PCR assay and negative by microscopic agglutination test (MAT) assay. Two CSF samples were positive by MAT and negative by PCR. The positive and negative agreement between both tests was 11 and 14, respectively. CSF samples from six cases of unknown diagnosis were positive by PCR assay. Eight cases showed positive results using PCR and MAT. Leptospirosis could be detected by PCR assay from the 3rd-26th day after illness onset. The sensitivity of the PCR was assessed with confirmed cases of leptospirosis (by MAT) and found to be 89.5%. All CSFs were negative by culture. PCR was found to be a powerful tool for diagnosing meningitis cases of leptospirosis. We recommend that it may be used as a supplementary diagnostic tool, especially in the early stages of the disease, when other diagnostic techniques such as serology are not sensitive.

[Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia]. / Síndrome da meningite asséptica por enterovírus e Leptospira sp em crianças de Salvador, Bahia.

For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia. In 44.6% (n=50), the etiologic agent for the diagnosis was laboratory-confirmed: enterovirus was identified in 37.7% (n=42) of the cases by the PCR Amplicor diagnostic kit, cerebrospinal fluid or fecal culture isolation; Leptospira sp. in 7.12% (n=8) by the microagglutination test; and arbovirus in non of the cases by inhibition of passive hemagglutination. In 14 of the 22 enteroviral isolates that were evaluated, 6 different serotypes were identified with Echovirus-4 being the major serotype (27.2%; 6/22) among all found (Coxsackie B2, B3, B6 and B9; Enterovirus 71). In conclusion, enteroviruses were the most frequent etiologic agent of AMS and that leptospirosis should be included in the differential diagnosis. In addition, patients with and without laboratory-confirmed identification of the etiologic agent had similar demographic and clinical characteristics and cerebrospinal fluid findings (p >0.05), therefore suggesting that patients without a confirmed diagnosis had enteroviral or leptospiral etiologies.

Síndrome da meningite asséptica por enterovírus e Leptospira sp em crianças de Salvador, Bahia / Aseptic meningitis syndrome due to enterovirus and Leptospira sp in children of Salvador, Bahia

Objetivando verificar a freqüência de enterovírus (EV), leptospiras e arbovírus como agentes causais da síndrome da meningite asséptica (SMA), em períodos näo-epidêmicos, e comparar os pacientes com e sem diagnóstico etiológico determinado, foram selecionados 112 pacientes de idade entre 3 meses e 15 anos, com suspeita clínica de SMA, referenciados para Hospital Couto Maia, especializado em Doenças Infecciosas e Parasitárias (Salvador, Bahia), Em 44,6 por cento (n=50) a etiologia foi determinada: enterovírus em 37,7 por cento (n=42) dos casos, pelo teste de PCR Amplicor, por cultura do líquor e/ou de fezes; a Leptospira sp. em 7,1 por cento (n=8), pelo método da micro-aglutinaçäo, e nenhum caso de arbovírus foi detectado (inibiçäo da hemaglutinaçäo passiva). Entre os 14 enterovírus dos 22 isolados, foram identificados seis diferentes sorotipos, sendo o Echovirus-4 predominante (27,2 por cento; 6/22) entre outros (Coxsackie B2, B3, B6 e B9; EV 71). Conclui-se que, os enterovírus foram os agentes mais freqüentes, e que a leptospirose deve ser lembrada no diagnóstico diferencial da SMA. Uma vez que as características clínicas e liquóricas dos pacientes dos grupos com e sem determinaçäo do agente etiológico foram semelhantes, pode-se supor que o diagnóstico presuntivo de SMA é de provável etiologia viral ou pela leptospira

Detection of Leptospira DNA in patients with aseptic meningitis by PCR.

Samples of cerebrospinal fluid from 103 patients with aseptic meningitis were tested by PCR for detection of leptospires, and the results were compared with those of the microscopic agglutination test (MAT) and an enzyme-linked immunosorbent assay for detection of immunoglobulin M (ELISA-IgM). Of these samples, 39.80% were positive by PCR and 8.74 and 3.88% were positive by MAT and ELISA-IgM, respectively.

Brote epidémico de meningitis aséptica: experiencias en un hospital infantil privado / Epidemic of aseptic meningitis experience of private hospital

Se informa acerca de las experiencias obtenidas en 193 niños con meningitis aséptica, estudiados durante un brote epidémico registrado entre febrero y julio de 1992. Los cultivos de líquido cefalorraquídeo hechos en el Instituto de Referencia Epidemiológica permitieron identificar al virus Echo 30 como un agente a la meningitis en 48 niños

Estudios de líquido cefalorraquídeo en meningitis: evaluación d la confiabilidad / Tests of cerebrospinal fluid in meningitis

MARCO TEORICO: Las meningitis representan un problema grave y frecuente en nuestro medio particularmente edades pediátricas. En vista de que su etiología es diversa resulta indispensable contar con estudios confiables y oportunos del LCR para dar un tratamiento específico. OBJETIVO: Determinar la frecuencia con la que se establecen los diagnósticos de meningitis aséptica y purulenta en nuestro Hospital, conocer el tipo de paciente en el que se realiza este diagnóstico y finalmente cuantificar el valor predictivo positivo (VVP) de los diversos componentes del estudio del LCR incluyendo los estudios citoquímicos, inmunológicos y microbiológicos. TIPO DE ESTUDIO: Clínico, epidemiológico, retrospectivo, observacional, comparativo, corte transversal de un período comprendido entre 1991 y 1992. Laspruebas de coaglutinación incluidad fueron: E. coli, H influenzae, S. pneumoniae, S. agalactiae, N. meniningitidis A,B, y C. (Sanofi Diagnostics. Pasteur, France). RESULTADOS: Se estudiaron 247 LCR de los cuales 25 por ciento procedieronn a pediatría, 19 por ciento de Medicina Interna y 15 por ciento del Servicio de Urgencias. En base a los estudios citoquímicos se consideró que 13 por ciento de los casos tenían características compatibles con meningitis aséptica y 7 por ciento con aspecto piógeno. Hubo desarrollo en 17 cultivos (7 por ciento), hubo Gram negativos en el 51 por ciento, neumococo fue el microrganismo más frecuente (30 por ciento). Solo se aisló Cándida en dos casos (1 por ciento). En la predicción de desarrollo las tinciones de Gram mostraron un VPP del 99 por ciento mientras que en la identificación del microrganismo las aglutinaciones tuvieron un VPP de 97 por ciento. En conjunto ambas determinaciones alcanzaron un VPP acumulativo del 100 por ciento. Los estudios citoquímicos tuvieron VPP bajos: Glucosa 86 por ciento, Proteínas 65 por ciento, leucocitos 59 por ciento, Eritrocitos 56 por ciento. CONCLUSION: Consideramos que las coaglutinaciones representan un significativo avance en microbiología por su confiabilidad y rapidez diagnóstica. Representan el complemento ideal de la tinción de Gram del cultivo y del antibiograma.

Preliminar characterization of a new virus isolated from the spinal fluid of patients with meningitis in Säo Paulo, Brazil

De dezembro de 1982 a março de 1983 um total de 138 pacientes com idade de 4 meses a 57 anos foram atendidos em diferentes hosptais de Säo Paulo com sintomas de meningite asséptica. Um agente transmissível foi isolado de 35 das 53 amostras de líquor. A replicaçäo desse novo vírus ou de um grupo de vírus relacioandos antigenicamente com características semelhantes foi detectada através do efeito citopático produzido em cultura de células de MDCK. O agente isolado demonstrou ter um diâmtro em torno de 40 nm quando examinado ao microscópio eletrônico através da coloraçäo negativa. Nenhuma atividade hemaglutinante foi detectada em pH 7,2 com hemácias humanas de cobaias ou de galinha e em pH 6,0 - 7,2 com hemácias de ganso. Esse agente näo se mostrou patogênico ao camundongo recém-nascido e adulto, era sensível ao clorofórmio e näo foi inibido pelo BuDR, o que indica conter o genoma RNA

Preliminary characterization of a new virus isolated from the spinal fluid of patients with meningitis in São Paulo, Brazil.

A total of 138 patients with the age of 4 months to 57 years were attended in different hospitals of São Paulo State with aseptic meningitis. A probable new agent was isolated from the cerebrospinal fluid of 35 of 53 specimens examined. Replication of the agent with similar characteristics was detected by CPE produced in the MDCK cell line. Virus-like particles measuring about 40 nm in diameter were observed by negative staining electron microscopy. No hemagglutinating activity was detected at pH 7.2 by using either human, guinea pig, chicken and at pH ranged 6.0-7.2 with goose red blood cells. The agent was not pathogenic to newborn or adult mice. Virus infectivity as measured by CPE was sensitive to chloroform and not inhibited by BuDR, suggesting that agent is an enveloped virus with RNA genome.

Aseptic meningitis due to echovirus 4 in Panama City, Republic of Panama.

Between September 23 and November 30, 1981, 1,032 children from Panamá City, Republic of Panamá were hospitalized with aseptic meningitis. Forty-four per cent of the cases were in the age group 5-9 years old; the disease was mild and self-limiting with an average hospital stay of five days. Echovirus 4 isolates were obtained from 48 of 160 patients. To identify risk factors associated with the epidemic, the authors randomly selected 10 per cent of hospitalized cases and conducted a family-based seroepidemiologic study. The closest neighboring house with at least one child younger than 15 years was similarly studied as a control. In total, 182 households and 1,083 of 1,177 residents were included. No risk factors ascertained by the study were associated with aseptic meningitis; however, several factors were related to recent echovirus 4 infection. Overall, 56 per cent of cases had echovirus 4 antibody, as did 29 per cent of their family members and 19 per cent of control family members. Children who attended kindergarten or primary school were more likely to have antibody than other household members and, within case families, individuals involved in child-care had an excess risk for infection.