Retrospective analysis of the etiology, clinical characteristics and outcomes of community-acquired bacterial meningitis in the University Infectious Diseases Centre in Lithuania.

BACKGROUND: The morbidity and mortality in community-acquired bacterial meningitis (CABM) remain substantial, and the etiology, clinical characteristics, treatment outcomes and predictors of poor prognosis must be assessed regularly. The aim of this study was to identify the distribution of etiological agents and their relationship with clinical characteristics, treatment and outcomes in this cohort of patients with CABM. METHODS: Our retrospective chart review analyzed the causative microorganisms, clinical characteristics, laboratory findings, treatment and outcomes of 159 adults with CABM hospitalized in the Infectious Diseases Centre of Vilnius University Hospital from January 1, 2009 to December 31, 2016. A Glasgow Outcome Scale (GOS) score ≤ 3 was defined as unfavorable outcome. Predictors of an unfavorable outcome were identified through logistic regression analysis. RESULTS: The median patient age was 36 (IQR 24-56), and 51.6% were male. Microbiologically confirmed causative agents were identified in 80 (50.3%) patients: N. meningitidis in 55 (34.6%) patients with serotype B accounting for 85% of cases, S. pneumoniae in 15 (9.4%), L. monocytogenes in 5 (3.1%) and other in 5 (3.1%). The clinical triad of fever, neck stiffness and a change in mental status was present in 59.1% of patients. Coexisting conditions and comorbidities were similar in all groups stratified by etiology. Initial antimicrobial treatment consisted of penicillin in 78 patients (49.1%) and ceftriaxone in 72 patients (45.3%). The median time in which antibiotic treatment was started was 40 min (IQR 30.0-90.0). The outcome was unfavorable in 15.7% of episodes and death occurred in 5.7% of cases and did not differ according to the causative agent. Risk factors for an unfavorable outcome were age > 65 years, coexisting pneumonia and a platelet count <150x10e9/l. CONCLUSIONS: The most common causative agent of CABM was N. meningitidis, with serotype B clearly dominant. Causative agents did not influence the disease outcome. The strongest risk factors for an unfavorable outcome were older age, pneumonia and a low platelet count. Since the introduction of routine vaccination against meningococcus B for infants in Lithuania in 2018, the national vaccination policy may hopefully contribute to a decrease in the incidence of serogroup B meningococcal disease in the Lithuanian population.

Prevalence of generalised joint hypermobility in school-aged children from east-central European region.

BACKGROUND: There is no literature regarding joint mobility in children of the Central and Eastern Europe. Studies describing clinical characteristics and functional outcomes are still needed. The aim of this study was to assess the prevalence of generalised joint hypermobility (GJH) in the group of school-aged children from Vilnius, the capital city of Lithuania, in relation to different cut-off values of the Beighton score (BS), and to identify possible patients with joint hypermobility syndrome. MATERIALS AND METHODS: The representative sample of this study was calculated to be 760 subjects. A total of 778 children from different schools were screened for the mobility of joints. The medical examination included an assessment of joints' hypermobility according to the BS. The presence of specific signs (marfanoid habitus, antimongoloid slant and drooping eyelids) was assessed additionally. Parents of all involved children were asked to answer the questions developed based on the Brighton criteria regarding the medical history of children. RESULTS: The prevalence of GJH in school-aged children from Vilnius, depending on the BS cut-off value, was 19.2% (BS ≥ 4), 9.5% (BS ≥ 5) or 5.7% (BS ≥ 6). The increased range of mobility was most frequently detected in thumbs of school- -aged children. The frequency of hyperextension > 10o in knees was 7- to 8-fold lower than the frequency of hyperextension > 10o in a passive opposition of the thumb. The evaluation results were similar on the left and right sides in 87.4% cases of thumb opposition, 90.1% cases of hyperextension of 5th finger, 87.9% cases of elbow manoeuvres, and 94.8% attempts to hyperextend knee. CONCLUSIONS: The prevalence of GJH in school-aged children from Vilnius depends on the BS cut-off value and ranges from 5.7% to 19.2%.