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1.
BMC Infect Dis ; 21(1): 85, 2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33468073

RESUMEN

BACKGROUND: To determine the phenotype, molecular characterisation and risk factors of postoperative meningitis induced by Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in China. METHODS: We performed a multi-centre comparative cohort study of postoperative meningitis patients infected with Enterobacteriaceae in 4 neurosurgical centres in China from January 2014 to December 2019. Phenotype and molecular characteristics of the isolates were reviewed and tested, and independent risk factors of the EPE meningitis were evaluated by binary logistic regression. RESULTS: In total, 220 Enterobacteriaceae include 78 EPE were available in this study. 85.6% (67/78) ESBL-related genes were tested, and blaSHV (14.9%) and blaSHV + blaTEM + blaCTX-M-9 (20.9%) were found to be the most frequent mono and combined ESBL-related genes harboured by Enterobacteriaceae. On binary logistic analysis, craniotomy (OR. 2.583, 95% C.I. 1.274-5.235, P = 0.008) and malignancy (OR. 2.406, 95% C.I. 1.299-4.456, P = 0.005) were the associated independent risk factors to meningitis induced by EPE. CONCLUSIONS: To the best of our knowledge, this is the largest series focusing on risk factors of EPE meningitis which has been conducted in China. Craniotomy and malignancy were independent risk factors for EPE meningitis. The risk factors identified may be further utilized in clinical practice and research to avoid and reduce the mortality in future.


Asunto(s)
Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/aislamiento & purificación , Meningitis Bacterianas/epidemiología , beta-Lactamasas/metabolismo , Adulto , China/epidemiología , Estudios de Cohortes , Enterobacteriaceae/genética , Enterobacteriaceae/metabolismo , Infecciones por Enterobacteriaceae/líquido cefalorraquídeo , Infecciones por Enterobacteriaceae/microbiología , Femenino , Humanos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiología , Fenotipo , Reacción en Cadena de la Polimerasa , Complicaciones Posoperatorias/líquido cefalorraquídeo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/microbiología , Estudios Retrospectivos , Factores de Riesgo
3.
Int J Infect Dis ; 97: 251-257, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32534141

RESUMEN

BACKGROUND: Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. OBJECTIVE: To describe the aetiology of BM in Angolan infants <90 days of age. METHODS: A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. RESULTS: Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. CONCLUSIONS: BM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.


Asunto(s)
Bacterias/aislamiento & purificación , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/microbiología , Angola , Antibacterianos/uso terapéutico , Bacterias/clasificación , Bacterias/genética , Femenino , Humanos , Lactante , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/tratamiento farmacológico , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos
4.
West Afr J Med ; 37(3): 290-294, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32476125

RESUMEN

BACKGROUND: In the face of an emergency, a decision on the need for a timely intervention must be made urgently especially when it has to do with the brain. This study was conducted to determine the usefulness of Urine combistix and glucometer as a "point of care" testing tool in the emergency analysis of cerebrospinal fluid (CSF) in resource-limited settings. METHODOLOGY: In this pilot cross-sectional study, CSF and blood glucose were simultaneously measured using a point of care glucometer and central laboratory. The CSF protein, glucose, blood and leucocytes were also assessed using the urine combistix strips. The CSF/blood glucose ratios obtained at the bedside with a glucometer versus those obtained by the central laboratory were also compared. RESULTS: Turn-around time for glucometer and Combistix analysis was 3.5minutes (3-4mins) versus 360minutes (300- 600minutes) for the laboratory. A strong correlation was observed amongst urine Combistix values for CSF protein, blood, leucocyte and glucose with those obtained from the laboratory (ROC of 0.875, sensitivity:75% and specificity: 100%). In addition, there was significant correlation of the CSF-blood glucose ratios from both the laboratory versus glucometer. CONCLUSION: This pilot study showed that a combination of Combistix analysis for CSF protein, glucose, blood and leucocyte values plus a glucometer analysis of CSF and blood glucose can serve as a reliable and accurate synergistic means for early diagnosis of CSF abnormalities particularly in patients suspected to have meningitis. Finally, it provides a template on which an accurate CSF diagnostic kit can be developed.


Asunto(s)
Glucemia/metabolismo , Líquido Cefalorraquídeo , Glucosa/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Sistemas de Atención de Punto , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Estudios Transversales , Humanos , Meningitis Bacterianas/sangre , Proyectos Piloto , Sensibilidad y Especificidad
5.
Eur J Clin Microbiol Infect Dis ; 39(4): 665-670, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31813079

RESUMEN

Pentraxin 3 (PTX3) is an acute phase protein; its plasmatic levels significantly rise during severe infections. Data on PTX3 levels in cerebrospinal fluid (CSF) of patients with central nervous system (CNS) infections are lacking. We aimed (a) to assess the diagnostic potential of measuring CSF PTX3 levels in patients with CNS infections and (b) to establish CSF PTX3 cutoffs to distinguish between bacterial and aseptic meningoencephalitis (ROC curve). PTX3 levels were measured in CSF from 19 patients admitted to Trieste Hospital, Italy, with CNS infection. A diagnosis of bacterial infection and aseptic meningoencephalitis was made in 7 (37%) and 12 (63%) patients, respectively. Subjects with bacterial infections showed significantly higher PTX3 levels (13.5 vs 1.27 ng/mL in aseptic meningoencephalitis, p = 0.010). We identified two different CSF PTX3 levels cutoffs. (1) The best cutoff to maximise Youden's J was 9.6 ng/mL with a sensitivity, specificity, positive predictive value and negative predictive value (NPV) of 71.4%, 91.4%, 83.3%, 84.6%, respectively. (2) The cutoff with higher NPV (100%) was 3.6 ng/mL; a diagnosis of bacterial infections was obtained in 0% patients with CSF PTX3 levels < 3.6 ng/mL vs 58% of those with CSF PTX3 levels ≥ 3.6 ng/mL (p = 0.017). CSF PTX3 levels are higher in bacterial meningitis than aseptic meningoencephalitis. A cutoff of 3.6 ng/mL of CSF PTX3 has a high NPV and can be used to exclude bacterial CNS infections.


Asunto(s)
Bacterias/aislamiento & purificación , Proteína C-Reactiva/líquido cefalorraquídeo , Infecciones del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones del Sistema Nervioso Central/diagnóstico , Meningitis Bacterianas/diagnóstico , Componente Amiloide P Sérico/líquido cefalorraquídeo , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/genética , Biomarcadores/líquido cefalorraquídeo , Diagnóstico Diferencial , Femenino , Humanos , Italia , Masculino , Meningitis Aséptica/líquido cefalorraquídeo , Meningitis Aséptica/diagnóstico , Meningitis Bacterianas/líquido cefalorraquídeo , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/clasificación , Meningoencefalitis/diagnóstico , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Sensibilidad y Especificidad , Punción Espinal
6.
Clin Microbiol Infect ; 26(4): 513.e7-513.e11, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31525519

RESUMEN

OBJECTIVE: Pneumonia is considered a focus of infection in patients presenting with community-acquired bacterial meningitis but the impact on disease course is unclear. The aim was to study presenting characteristics, clinical course and outcome of meningitis patients with co-existing pneumonia on admission. METHODS: We evaluated adult patients with community-acquired bacterial meningitis with pneumonia on admission in a nationwide, prospective cohort performed from March 2006 to June 2017. We performed logistic regression analysis to identify clinical characteristics predictive of pneumonia on admission, and to quantify the effect of pneumonia on outcome. RESULTS: Pneumonia was diagnosed on admission in 315 of 1852 (17%) bacterial meningitis episodes and confirmed by chest X-ray in 256 of 308 (83%) episodes. Streptococcus pneumoniae was the causative organism in 256 of 315 episodes (81%). Pneumonia on admission was associated with advanced age (OR 1.03 per year increase, 95% CI 1.02-1.04, p < 0.001), alcoholism (OR 1.96, 95% CI 1.23-3.14, p 0.004), cancer (OR 1.54, 95% CI 1.12-2.13, p 0.008), absence of otitis or sinusitis (OR 0.44, 95% CI 0.32-0.59, p < 0.001) and S. pneumoniae (OR 2.14, 95% CI 1.55-2.95, p < 0.001) in the multivariate analysis. An unfavourable outcome defined as a score of 1-4 on the Glasgow Outcome Scale was observed in 172 (55%) episodes and 87 patients (28%) died. Pneumonia on admission was independently associated with unfavourable outcome and mortality in the multivariate analysis (OR 1.48, 95% CI 1.12-1.96; p 0.005). CONCLUSION: Pneumonia on admission in bacterial meningitis is a frequent coexisting infection and is independently associated with unfavourable outcome and mortality.


Asunto(s)
Infecciones Comunitarias Adquiridas/microbiología , Meningitis Bacterianas/complicaciones , Neumonía/microbiología , Anciano , Antibacterianos/uso terapéutico , Femenino , Humanos , Modelos Logísticos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/tratamiento farmacológico , Persona de Mediana Edad , Países Bajos , Neumonía/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Factores de Riesgo
7.
Turk Neurosurg ; 30(4): 513-519, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31099887

RESUMEN

AIM: To measure cytokine and lactate levels in the cerebrospinal fluid (CSF) of patients with suspected post-neurosurgical meningitis. MATERIAL AND METHODS: Interleukin (IL)-8,-12, and -13, interferon (IFN) gamma, and lactate concentrations were determined in the CSF of patients diagnosed with meningitis, who were undergoing follow-up after neurosurgical procedures at the Neurosurgery Clinic between May 2016 and November 2017. The demographic, clinical, biochemical, CSF cell count, CSF biochemistry, and CSF culture results of 119 patients were recorded. RESULTS: The study group consisted of 39 patients diagnosed with post-neurosurgical meningitis. The control group comprised of 80 patients without pleocytosis, who had undergone lumbar puncture due to various indications. In the study group, 59% of the patients had fever, 66.7% had deterioration in the level of consciousness, and 35.9% had neck stiffness. The levels of IL-8 (96.5 ng/L vs. 86.6 ng/L, p < 0.001), IL-12 (10.1 ng/L vs. 3 ng/L, p < 0.001), and lactate (5.9 mmol/L vs. 2.1 mmol/L, p < 0.001) were higher in the CSF of the patient group compared to the control group. However, IL-13 (32.7 ng/L vs. 42.5 ng/L, p=0.003) and IFN gamma (73.3 ng/L vs. 260.4 ng/L, p < 0.001) levels were lower in patients compared to controls. The mortality rate in post-neurosurgical meningitis patients was estimated to be 35.9%. CONCLUSION: Post-neurosurgical meningitis prolongs the duration of hospital stay and causes long-term sequelae. Therefore, measurement of CSF cytokine and lactate levels alongside meningitis diagnostic processes may facilitate early and accurate diagnosis. Measuring CSF lactate is inexpensive and cost effective, particularly in post-neurosurgical patients.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/líquido cefalorraquídeo , Adulto , Citocinas/líquido cefalorraquídeo , Femenino , Humanos , Ácido Láctico/líquido cefalorraquídeo , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico
8.
Afr Health Sci ; 20(3): 1124-1132, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33402957

RESUMEN

Background: Since the 1990s, the epidemiology of bacterial meningitis worldwide has changed thanks to vaccination. In Tunisia, the main causative pathogens were Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae serotype b (Hib). Only Hib vaccination was available during our study period. Objectives: We performed a laboratory case report based-study of suspected bacterial meningitis in Northern Tunisia from January 2014 to June 2017. Methods: CSF samples obtained from children beyond neonatal age with suspicion of meningitis were tested by two real time PCRs, targeting pneumococcus, meningococcus and Hib, and conventional methods. Results: Using real-time PCR, 63 were positive including ten supplementary cases compared to conventional methods. A general decrease of bacterial meningitis cases was demonstrated comparing to previous data. Pneumococcus was predominant (69.84%) followed by meningococcus (28.57%) and Hib (1.59%). The main serotypes were 14, 19F, 6B and 23F for pneumococcus and serogroup B for meningococcus. Most cases occurred during cold season and children under one year were the most affected by bacterial meningitis. Conclusion: Our study suggests the predominance of pneumococcal cases. It may provide valuable data on meningitis epidemiology before the introduction of pneumococcal vaccine, which may be useful for future evaluation.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , Haemophilus influenzae tipo b/genética , Meningitis Bacterianas/epidemiología , Neisseria meningitidis/genética , Streptococcus pneumoniae/genética , Niño , Preescolar , ADN Bacteriano , Estudios Epidemiológicos , Femenino , Haemophilus influenzae tipo b/aislamiento & purificación , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Meningitis Bacterianas/microbiología , Neisseria meningitidis/aislamiento & purificación , Vigilancia de la Población , Reacción en Cadena en Tiempo Real de la Polimerasa , Estaciones del Año , Streptococcus pneumoniae/aislamiento & purificación , Túnez/epidemiología
9.
Braz. j. infect. dis ; 23(6): 468-470, Nov.-Dec. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1089315

RESUMEN

ABSTRACT The precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods for bacterial meningitis lack sensitivity or take too long for a final result. Therefore, other methods for rapid and accurate diagnosis of central nervous system infections are required. FilmArray meningitis/encephalitis (ME) panel is a PCR multiplex for simultaneous and rapid identification of 14 pathogens, including 6 bacteria, 7 viruses, and Cryptococcus. We evaluated 436 CSF samples submitted to FilmArray ME Panel. Among them, 25 cases were positive for bacteria, being Streptococcus pneumonia the most frequent (48 %). Among positive cases for bacteria, 60 % were positive only with FilmArray. All the bacterial meningitis cases in which the only positive test was FilmArray had CSF findings suggestive of bacterial meningitis, including neutrophilic pleocytosis, increased CSF protein and lactate, and decreased CSF glucose. These findings suggest that FilmArray may increase the diagnostic sensitivity for bacterial meningitis.


Asunto(s)
Humanos , Líquido Cefalorraquídeo/microbiología , Líquido Cefalorraquídeo/virología , Meningitis Bacterianas/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Bacterias/aislamiento & purificación , Virus/aislamiento & purificación , Pruebas de Sensibilidad Microbiana/métodos , Sensibilidad y Especificidad , Meningitis Bacterianas/líquido cefalorraquídeo
10.
Braz J Infect Dis ; 23(6): 468-470, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31738885

RESUMEN

The precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods for bacterial meningitis lack sensitivity or take too long for a final result. Therefore, other methods for rapid and accurate diagnosis of central nervous system infections are required. FilmArray meningitis/encephalitis (ME) panel is a PCR multiplex for simultaneous and rapid identification of 14 pathogens, including 6 bacteria, 7 viruses, and Cryptococcus. We evaluated 436 CSF samples submitted to FilmArray ME Panel. Among them, 25 cases were positive for bacteria, being Streptococcus pneumonia the most frequent (48 %). Among positive cases for bacteria, 60 % were positive only with FilmArray. All the bacterial meningitis cases in which the only positive test was FilmArray had CSF findings suggestive of bacterial meningitis, including neutrophilic pleocytosis, increased CSF protein and lactate, and decreased CSF glucose. These findings suggest that FilmArray may increase the diagnostic sensitivity for bacterial meningitis.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , Líquido Cefalorraquídeo/virología , Meningitis Bacterianas/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Bacterias/aislamiento & purificación , Humanos , Meningitis Bacterianas/líquido cefalorraquídeo , Pruebas de Sensibilidad Microbiana/métodos , Sensibilidad y Especificidad , Virus/aislamiento & purificación
11.
J Neuroinflammation ; 16(1): 219, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31727097

RESUMEN

BACKGROUND: Cytokines play multiple roles during neuro-inflammatory processes and several cytokines have been studied in the context of specific diseases. This study provides a comprehensive picture of cerebrospinal fluid (CSF) changes during neuro-inflammation by analyzing multiple cytokines in combination with immune cell subsets and standard CSF parameters. METHODS: Using multiplex assays, we simultaneously measured 36 cytokines (CCL1-3, CCL7, CCL8, CCL11, CCL13, CCL19, CCL20, CCL22-27, CXCL1, CXCL2, CXCL5, CXCL6, CXCL8, CXCL9, CXCL11-13, CXCL16, CX3CL1, IL2, IL4, IL6, IL10, IL16, GM-CSF, IFNγ, MIF, TNFα, and MIB1ß) in the CSF and serum of 75 subjects. Diagnoses included clinically isolated syndrome and relapsing-remitting multiple sclerosis (MS, n = 18), secondary progressive MS (n = 8), neuro-syphilis (n = 6), Lyme neuro-borreliosis (n = 13), bacterial and viral meningitis (n = 20), and patients with non-inflammatory neurological diseases (NIND, n = 10). Cytokine concentrations were correlated with CSF standard parameters and CSF immune cell subsets (CD4 and CD8 T cells, B cells, plasmablasts, monocytes, and NK cells) quantified by flow cytometry. RESULTS: We observed increased levels of multiple cytokines (26/36) in patients with neuro-inflammatory diseases when compared to NIND that consistently correlated with CSF cell count and QAlbumin. Most CSF cytokine concentrations correlated with each other, but correlations between CSF and serum values were scarce (3/36). Within the CSF compartment, CXCL13 showed a strong association with B cells when analyzing all patients, as well as patients with an intact blood-brain barrier (BBB). NK cells positively correlated with CSF concentrations of multiple cytokines (22/36) when analyzing all patients. These correlations were maintained when looking at patients with a disrupted BBB but not detectable in patients with an intact BBB. CONCLUSIONS: Under conditions of neuro-inflammation, multiple CSF cytokines are regulated in parallel and most likely produced locally. A combined increase of CSF CXCL13 levels and B cells occurs under conditions of an intact BBB. Under conditions of a disrupted BBB, CSF NK cells show significantly increased values and seem to have a major contribution to overall inflammatory processes, reflected by a strong correlation with multiple cytokines. Future studies are necessary to address the exact kinetics of these cytokines during neuro-inflammation and their relation to specific diseases phenotypes.


Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Citocinas/líquido cefalorraquídeo , Células Asesinas Naturales/inmunología , Meningitis Bacterianas/inmunología , Monocitos/inmunología , Esclerosis Múltiple/inmunología , Neurosífilis/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Citometría de Flujo , Humanos , Inflamación/líquido cefalorraquídeo , Inflamación/inmunología , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Persona de Mediana Edad , Esclerosis Múltiple/líquido cefalorraquídeo , Neurosífilis/líquido cefalorraquídeo , Adulto Joven
12.
Hosp Pediatr ; 9(12): 979-982, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31690569

RESUMEN

OBJECTIVES: We aimed to describe the cerebrospinal fluid (CSF) profiles of infants ≤60 days old with bacterial meningitis and the characteristics of infants with bacterial meningitis who did not have CSF abnormalities. METHODS: We included infants ≤60 days old with culture-positive bacterial meningitis who were evaluated in the emergency departments of 11 children's hospitals between July 1, 2011, and June 30, 2016. From medical records, we abstracted clinical and laboratory data. For infants with traumatic lumbar punctures (CSF red blood cell count of ≥10 000 cells per mm3), we used a red blood cell count/white blood cell (WBC) count correction factor of 1000:1 to determine the corrected CSF WBC count. We calculated the sensitivity for bacterial meningitis of a CSF Gram-stain and corrected CSF pleocytosis (≥16 WBCs per mm3 for infants ≤28 days old and ≥10 WBCs per mm3 for infants 29-60 days old). RESULTS: Among 66 infants with bacterial meningitis, the sensitivity of a CSF Gram-stain was 71.9% (95% confidence interval [CI]: 59.2-82.4), and the sensitivity of corrected CSF pleocytosis was 80.3% (95% CI: 68.7-89.1). The sensitivity of combining positive Gram-stain results with corrected CSF pleocytosis was 86.4% (95% CI: 75.7-93.6). Of 9 infants with meningitis who had a negative Gram-stain result and no corrected CSF pleocytosis, 8 (88.9%) had either an abnormal peripheral WBC count (>15 000 or <5000 cells per µL) or bandemia >10%. CONCLUSIONS: Most infants ≤60 days old with bacterial meningitis have CSF pleocytosis or a positive Gram-stain result. Infants with no CSF pleocytosis and a negative Gram-stain result are unlikely to have bacterial meningitis in the absence of other laboratory abnormalities.


Asunto(s)
Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Violeta de Genciana , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Recuento de Leucocitos , Masculino , Registros Médicos , Fenazinas , Sensibilidad y Especificidad
14.
Artículo en Inglés | MEDLINE | ID: mdl-31632699

RESUMEN

Study design: Retrospective case series. Objectives: To describe the epidemiological, clinical, MRI and therapeutic features and the outcomes of patients with syphilitic myelitis in a third-level hospital in Marrakesh in southern Morocco. Setting: The Neurology Department, University Hospital Mohamed VI Marrakesh, Morocco. Methods: Twelve charts of persons with syphilitic myelitis over a period of 17 years were reviewed to determine demographics, presenting symptoms, clinical and radiological findings, biological features, treatment received and outcomes. Results: There were 120 reports of neurosyphilis. Twelve patients (10%) had syphilitic myelitis. Eleven patients (92%) were male with mean age of 44 at presentation. Tabes dorsalis was the most common clinical form. Cerebrospinal fluid analysis showed lymphocytic meningitis in nine patients (75%). Spine MRI was abnormal in four patients (33%). All patients were treated with 30 million units of aqueous penicillin G IV per day for 10 days, every 3 months. In follow-up, two patients (17%) with clinical syphilitic meningomyelitis improved significantly, eight patients (66%) with tabes dorsalis and subacute transverse myelitis showed partial improvement but clinical status was stationary for two patients (17%) with Erb paraplegia. Conclusions: All patients with myelopathy should undergo syphilitic serology because of nonspecific manifestations and curability of this disease.


Asunto(s)
Meningitis Bacterianas , Mielitis , Neurosífilis , Adulto , Femenino , Humanos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/diagnóstico por imagen , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/terapia , Persona de Mediana Edad , Marruecos/epidemiología , Mielitis/líquido cefalorraquídeo , Mielitis/diagnóstico por imagen , Mielitis/epidemiología , Mielitis/terapia , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/diagnóstico por imagen , Neurosífilis/epidemiología , Neurosífilis/terapia , Estudios Retrospectivos , Tabes Dorsal/líquido cefalorraquídeo , Tabes Dorsal/diagnóstico por imagen , Tabes Dorsal/epidemiología , Tabes Dorsal/terapia
15.
Clin Infect Dis ; 69(Suppl 2): S105-S113, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505627

RESUMEN

BACKGROUND: Invasive bacterial diseases cause significant disease and death in sub-Saharan Africa. Several are vaccine preventable, although the impact of new vaccines and vaccine policies on disease patterns in these communities is poorly understood owing to limited surveillance data. METHODS: We conducted a hospital-based surveillance of invasive bacterial diseases in The Gambia where blood and cerebrospinal fluid (CSF) samples of hospitalized participants were processed. Three surveillance periods were defined in relation to the introduction of pneumococcal conjugate vaccines (PCVs), before (2005- 2009), during (2010-2011) and after (2012-2015) PCV introduction. We determined the prevalences of commonly isolated bacteria and compared them between the different surveillance periods. RESULTS: A total of 14 715 blood and 1103 CSF samples were collected over 11 years; overall, 1045 clinically significant organisms were isolated from 957 patients (972 organisms [6.6%] from blood and 73 [6.6%] from CSF). The most common blood culture isolates were Streptococcus pneumoniae (24.9%), Staphylococcus aureus (22.0%), Escherichia coli (10.9%), and nontyphoidal Salmonella (10.0%). Between the pre-PCV and post-PCV eras, the prevalence of S. pneumoniae bacteremia dropped across all age groups (from 32.4% to 16.5%; odds ratio, 0.41; 95% confidence interval, .29-.58) while S. aureus increased in prevalence, becoming the most prevalent bacteria (from 16.9% to 27.2%; 1.75; 1.26-2.44). Overall, S. pneumoniae (53.4%), Neisseria meningitidis (13.7%), and Haemophilus influenzae (12.3%) were the predominant isolates from CSF. Antimicrobial resistance to common antibiotics was low. CONCLUSIONS: Our findings demonstrate that surveillance data on the predominant pathogens associated with invasive disease is necessary to inform vaccine priorities and appropriate management of patients.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Hospitales/estadística & datos numéricos , Vigilancia de Guardia , Población Urbana , Antibacterianos/farmacología , Bacteriemia/epidemiología , Infecciones Bacterianas/sangre , Preescolar , Gambia/epidemiología , Haemophilus influenzae/clasificación , Humanos , Lactante , Meningitis Bacterianas/sangre , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/epidemiología , Neisseria meningitidis/clasificación , Prevalencia , Serotipificación
16.
Clin Infect Dis ; 69(Suppl 2): S140-S147, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505630

RESUMEN

BACKGROUND: Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011-2016. METHODS: Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. RESULTS: A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0-11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08-24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. CONCLUSIONS: The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.


Asunto(s)
Meningitis Bacterianas/epidemiología , Vacunas Neumococicas/administración & dosificación , Vigilancia de Guardia , Benin/epidemiología , Preescolar , Femenino , Haemophilus influenzae/clasificación , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiología , Neisseria meningitidis/clasificación , Serotipificación , Streptococcus pneumoniae/clasificación , Vacunas Conjugadas/administración & dosificación
17.
Clin Infect Dis ; 69(Suppl 2): S121-S125, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505632

RESUMEN

BACKGROUND: The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age. METHODS: During 2010-2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010-2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013-2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction. RESULTS: In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died. CONCLUSIONS: Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.


Asunto(s)
Hospitalización/estadística & datos numéricos , Meningitis Bacterianas/prevención & control , Vacunas Neumococicas/administración & dosificación , Vigilancia de Guardia , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Madagascar/epidemiología , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/epidemiología , Neumonía Bacteriana/epidemiología
18.
Clin Infect Dis ; 69(Suppl 2): S148-S155, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505633

RESUMEN

BACKGROUND: Meningitis is endemic to regions of Cameroon outside the meningitis belt including the capital city, Yaoundé. Through surveillance, we studied the etiology and molecular epidemiology of pediatric bacterial meningitis in Yaoundé from 2010 to 2016. METHODS: Lumbar puncture was performed on 5958 suspected meningitis cases; 765 specimens were further tested by culture, latex agglutination, and/or polymerase chain reaction (PCR). Serotyping/grouping, antimicrobial susceptibility testing, and/or whole genome sequencing were performed where applicable. RESULTS: The leading pathogens detected among the 126 confirmed cases were Streptococcus pneumoniae (93 [73.8%]), Haemophilus influenzae (18 [14.3%]), and Neisseria meningitidis (15 [11.9%]). We identified more vaccine serotypes (19 [61%]) than nonvaccine serotypes (12 [39%]); however, in the latter years non-pneumococcal conjugate vaccine serotypes were more common. Whole genome data on 29 S. pneumoniae isolates identified related strains (<30 single-nucleotide polymorphism difference). All but 1 of the genomes harbored a resistance genotype to at least 1 antibiotic, and vaccine serotypes harbored more resistance genes than nonvaccine serotypes (P < .05). Of 9 cases of H. influenzae, 8 were type b (Hib) and 1 was type f. However, the cases of Hib were either in unvaccinated individuals or children who had not yet received all 3 doses. We were unable to serogroup the N. meningitidis cases by PCR. CONCLUSIONS: Streptococcus pneumoniae remains a leading cause of pediatric bacterial meningitis, and nonvaccine serotypes may play a bigger role in disease etiology in the postvaccine era. There is evidence of Hib disease among children in Cameroon, which warrants further investigation.


Asunto(s)
Hospitales/estadística & datos numéricos , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/microbiología , Antibacterianos/farmacología , Camerún/epidemiología , Preescolar , Farmacorresistencia Bacteriana , Femenino , Haemophilus influenzae tipo b/clasificación , Haemophilus influenzae tipo b/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Neisseria meningitidis/clasificación , Neisseria meningitidis/efectos de los fármacos , Vigilancia de la Población , Serogrupo , Serotipificación , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/efectos de los fármacos , Secuenciación Completa del Genoma
19.
Clin Infect Dis ; 69(Suppl 2): S156-S163, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505635

RESUMEN

BACKGROUND: Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization-coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. METHODS: Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d'Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS: A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. CONCLUSIONS: There has been a decline in pneumococcal meningitis post-pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.


Asunto(s)
Meningitis Bacterianas/epidemiología , Vacunas Neumococicas/administración & dosificación , Vigilancia de Guardia , Preescolar , Femenino , Haemophilus influenzae/clasificación , Humanos , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/mortalidad , Neisseria meningitidis/clasificación , Senegal/epidemiología , Serotipificación , Streptococcus pneumoniae/clasificación , Combinación Trimetoprim y Sulfametoxazol/farmacología , Vacunas Conjugadas/administración & dosificación , Secuenciación Completa del Genoma
20.
Clin Infect Dis ; 69(Suppl 2): S133-S139, 2019 09 05.
Artículo en Inglés | MEDLINE | ID: mdl-31505636

RESUMEN

BACKGROUND: Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010-2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016. METHODS: Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates. RESULTS: The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates. CONCLUSIONS: Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis.


Asunto(s)
Hospitales/estadística & datos numéricos , Meningitis Bacterianas/epidemiología , Neisseria meningitidis Serogrupo C/clasificación , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/clasificación , Preescolar , Femenino , Haemophilus influenzae/clasificación , Humanos , Programas de Inmunización , Lactante , Recién Nacido , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/prevención & control , Niger/epidemiología , Vigilancia de la Población , Serogrupo , Serotipificación , Secuenciación Completa del Genoma
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