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2.
Artículo en Portugués | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1150416

RESUMEN

Objetivo: Analisar o perfil epidemiológico da meningite em crianças no Brasil. Método: Trata-se de estudo descritivo, cujos dados foram obtidos através de análise documental do Departamento de Informática do Sistema Único de Saúde (DATASUS) por meio de dados disponibilizados pela notificação no Sistema de Informação e Agravos de Notificação (Sinan). Foram utilizados dados da notificação de meningite no período de 2008 a 2019, em crianças até os 14 anos de idade no país. Resultados: Na faixa etária pediátrica, foram notificados 127.508 casos, o equivalente a 55,83% de todos os diagnósticos realizados neste período em todas as faixas etárias. Na amostra, houve maior prevalência da faixa etária entre 1 ano a 4 anos. Em relação ao sexo, o masculino foi o mais prevalente. Quanto à evolução dos casos notificados, a maioria dos pacientes tiveram alta hospitalar. Destes, a faixa etária entre 1 a 4 anos obteve maior prevalência. Quanto aos óbitos por meningite, houve maior prevalência da faixa etária de menores de 1 ano. O método quimiocitológico foi o método diagnóstico mais utilizado, evidenciando principalmente a meningite de etiologia viral. Conclusão: Verifica-se que os casos de meningite são prevalentes na faixa etária pediátrica, havendo predomínio da faixa etária entre 1 a 4 anos e do sexo masculino neste estudo. Ressalta-se a importância de ações preventivas, como a imunização vacinal, sobretudo quando se percebe a maior letalidade da meningite bacteriana


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Meningitis/epidemiología , Brasil/epidemiología , Hospitalización/estadística & datos numéricos , Meningitis/diagnóstico , Meningitis/etiología
3.
Emerg Med Clin North Am ; 39(1): 47-65, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33218662

RESUMEN

The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.


Asunto(s)
Urgencias Médicas , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedad Aguda , Factores de Edad , Anciano , Niño , Demencia/diagnóstico , Demencia/terapia , Servicio de Urgencia en Hospital , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/terapia , Meningitis/diagnóstico , Meningitis/terapia , Enfermedades del Sistema Nervioso/terapia , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/terapia , Convulsiones/diagnóstico , Convulsiones/terapia , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia
4.
Arq. neuropsiquiatr ; 78(12): 797-804, Dec. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1142378

RESUMEN

ABSTRACT Importance: Hypertrophic pachymeningitis (HP) is a non-usual manifestation of rheumatologic, infectious, and neoplastic diseases. Etiological diagnosis is a challenge, but when made promptly it creates a window of opportunity for treatment, with the possibility of a total reversal of symptoms. Observations: HP is an inflammatory process of the dura mater that can occur as a manifestation of sarcoidosis, granulomatosis with polyangiitis, and IgG4-related disease. The HP case evaluation is extensive and includes central nervous system imaging, cerebrospinal fluid analysis, serology, rheumatologic tests, and systemic survey for other manifestations sites. After systemic investigation, meningeal biopsy might be necessary. Etiology guides HP treatment, and autoimmune disorders are treated with corticosteroids alone or associated with an immunosuppressor. Conclusion: HP is a manifestation of several diseases, and a precise etiological diagnosis is crucial because of the difference among treatments. An extensive investigation of patients with HP helps early diagnosis and correct treatment.


RESUMO Importância: Paquimeningite hipertrófica (PH) é uma manifestação não usual de doenças reumatológicas, infecciosas e neoplásicas. O diagnóstico etiológico por vezes é um desafio, entretanto quando realizado em tempo cria uma janela de tratamento com a possibilidade de reversão total dos sintomas. Observações: A PH é um processo inflamatório da dura-máter que pode ocorrer como manifestação da sarcoidose, granulomatose com poliangeíte e doença relacionada à IgG4. A avaliação dos casos de PH é extensa e inclui imagem do sistema nervoso central, análise de líquor, sorologias, provas reumatológicas e rastreio sistêmico para doença em outros sítios. Por vezes, após toda a investigação sistêmica, a biópsia de meninge é necessária. A etiologia orienta o tratamento da HP, sendo que em doenças autoimunes adota-se o uso de corticosteroides isolados ou associados a um imunossupressor. Conclusão e Relevância: A PH é uma manifestação de várias doenças, e seu diagnóstico etiológico preciso é fundamental, visto a diferença entre os possíveis tratamentos. Uma investigação ampla nos casos de PH ajuda no diagnóstico precoce e tratamento adequado.


Asunto(s)
Humanos , Meningitis/diagnóstico , Meningitis/tratamiento farmacológico , Imagen por Resonancia Magnética , Corticoesteroides , Duramadre/diagnóstico por imagen , Hipertrofia
5.
PLoS Negl Trop Dis ; 14(12): e0008937, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33351806

RESUMEN

BACKGROUND: Eosinophilic meningitis (EM) is a rare clinical syndrome caused by both infectious and noninfectious diseases. In tropical pacific countries, Angiostrongylus cantonensis is the most common cause. However, the EM definition varies in the literature, and its relation to parasitic meningitis (PM) remains unclear. METHODOLOGY/PRINCIPAL FINDINGS: Adult and adolescent patients of 13 years old or above with suspected central nervous system (CNS) infections with abnormal CSF findings were prospectively enrolled at a tertiary referral hospital in Hanoi, Vietnam from June 2012 to May 2014. Patients with EM or suspected PM (EM/PM) were defined by the presence of either ≥10% eosinophils or an absolute eosinophil cell counts of ≥10/mm3 in the CSF or blood eosinophilia (>16% of WBCs) without CSF eosinophils. In total 679 patients were enrolled: 7 (1.03%) had ≥10% CSF eosinophilia, 20 (2.95%) had ≥10/mm3 CSF eosinophilia, and 7 (1.03%) had >16% blood eosinophilia. The patients with ≥10% CSF eosinophilia were significantly younger (p = 0.017), had a lower body temperature (p = 0.036) than patients with ≥10/mm3 CSF eosinophilia among whom bacterial pathogens were detected in 72.2% (13/18) of those who were tested by culture and/or PCR. In contrast, the characteristics of the patients with >16% blood eosinophilia resembled those of patients with ≥10% CSF eosinophilia. We further conducted serological tests and real-time PCR to identify A. cantonensis. Serology or real-time PCR was positive in 3 (42.8%) patients with ≥10% CSF eosinophilia and 6 (85.7%) patients with >16% blood eosinophilia without CSF eosinophils but none of patients with ≥10/mm3 CSF eosinophilia. CONCLUSIONS: The etiology of PM in northern Vietnam is A. cantonensis. The eosinophil percentage is a more reliable predictor of parasitic EM than absolute eosinophil count in the CSF. Patients with PM may present with a high percentage of eosinophils in the peripheral blood but not in the CSF.


Asunto(s)
Angiostrongylus cantonensis/aislamiento & purificación , Eosinofilia/diagnóstico , Meningitis/diagnóstico , Infecciones por Strongylida/diagnóstico , Adulto , Animales , Eosinofilia/sangre , Eosinofilia/parasitología , Femenino , Humanos , Recuento de Leucocitos , Masculino , Meningitis/sangre , Meningitis/parasitología , Persona de Mediana Edad , Infecciones por Strongylida/sangre , Infecciones por Strongylida/parasitología
7.
Rinsho Shinkeigaku ; 60(9): 631-635, 2020 Sep 29.
Artículo en Japonés | MEDLINE | ID: mdl-32779602

RESUMEN

We report a 62-year-old female with rheumatoid meningitis. She presented with mental disorder, loss of consciousness, generalized seizures, and cognitive impairment. Brain MRI demonstrated high intensity lesions and abnormal enhancement along the left frontal and parietal sulci. Her serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptides (CCP) antibody, and the antibody index of cerebrospinal fluid anti-CCP antibody increased, which led us to suspect rheumatoid meningitis. Her symptoms improved immediately by methylpredonisolone pulse therapy and anti-CCP antibody turned negative in cerebrospinal fluid. However, she revealed arthritis with the reduction of betamethasone and was diagnosed as rheumatoid arthritis. We suggest that the elevation of antibody index of cerebrospinal fluid anti-CCP antibody is useful in the diagnosis of rheumatoid meningitis preceding neurological symptoms without arthritis, and anti-CCP antibody in cerebrospinal fluid may be helpful as the evaluation of the treatment.


Asunto(s)
Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Autoanticuerpos/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis/etiología , Enfermedades del Sistema Nervioso/etiología , Péptidos Cíclicos/inmunología , Artritis Reumatoide/tratamiento farmacológico , Biomarcadores/líquido cefalorraquídeo , Femenino , Humanos , Meningitis/tratamiento farmacológico , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Quimioterapia por Pulso , Resultado del Tratamiento
8.
Epidemiol Infect ; 148: e173, 2020 07 27.
Artículo en Inglés | MEDLINE | ID: mdl-32713368

RESUMEN

The Biofire® Film Array Meningitis Encephalitis (FAME) panel can rapidly diagnose common aetiologies but its impact in Colombia is unknown. A retrospective study of adults with CNS infections in one tertiary hospital in Colombia. The cohort was divided into two time periods: before and after the implementation of the Biofire® FAME panel in May 2016. A total of 98 patients were enrolled, 52 and 46 were enrolled in the Standard of Care (SOC) group and in the FAME group, respectively. The most common comorbidity was human immunodeficiency virus infection (47.4%). The median time to a change in therapy was significantly shorter in the FAME group than in the SOC group (3 vs. 137.3 h, P < 0.001). This difference was driven by the timing to appropriate therapy (2.1 vs. 195 h, P < 0.001) by identifying viral aetiologies. Overall outcomes and length of stay were no different between both groups (P > 0.2). The FAME panel detected six aetiologies that had negative cultures but missed identifying one patient with Cryptococcus neoformans. The introduction of the Biofire FAME panel in Colombia has facilitated the identification of viral pathogens and has significantly reduced the time to the adjustment of empirical antimicrobial therapy.


Asunto(s)
Encefalitis/diagnóstico , Encefalitis/epidemiología , Meningitis/diagnóstico , Meningitis/epidemiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Encefalitis/tratamiento farmacológico , Femenino , Humanos , Masculino , Meningitis/tratamiento farmacológico , Persona de Mediana Edad , Estudios Retrospectivos
10.
Cochrane Database Syst Rev ; 6: CD012824, 2020 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-32524581

RESUMEN

BACKGROUND: Meningitis is inflammation of the meninges, the layers that protect the brain and spinal cord. Acute meningitis is an emergent disease that develops over the course of hours to several days. Delay in treatment can lead to serious outcomes. Inflammation of the meninges is assessed by analysing cerebrospinal fluid. Identifying the pathogen in cerebrospinal fluid is another way to diagnose meningitis. Cerebrospinal fluid is collected by doing a lumbar puncture, which is an invasive test, and can be avoided if a physical examination excludes the diagnosis of meningitis. However, most physical examinations, such as nuchal rigidity, Kernig's test, and Brudzinski's test, are not sufficiently sensitive to exclude meningitis completely. Jolt accentuation of headache is a new and less well-recognised physical examination, which assesses meningeal irritation. It is judged as positive if the headache is exacerbated by rotating the head horizontally two or three times per second. A 1991 observational study initially reported high sensitivity of this examination to predict pleocytosis. Pleocytosis, an abnormally high cerebrospinal fluid sample white cell count, is an accepted indicator of nervous system infection or inflammation. Jolt accentuation of headache may therefore accurately rule out meningitis without the use of lumbar puncture. However, more recent cross-sectional studies have reported variable diagnostic accuracy. OBJECTIVES: To estimate the diagnostic accuracy of jolt accentuation of headache for detecting acute meningitis in emergency settings. Secondary objectives: to investigate the sources of heterogeneity, including study population, patient condition, and types of meningitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), and Embase (Elsevier) to 27 April 2020. We searched ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and Ichushi-Web Version 5.0 to 28 April 2020. SELECTION CRITERIA: We included cross-sectional studies that assessed the diagnostic accuracy of jolt accentuation of headache for people with suspected meningitis in emergency settings. We included participants of any age and any severity of illness. Meningitis should be diagnosed with any reference standard, such as cerebrospinal fluid pleocytosis, proof of causative agents, or autopsy. DATA COLLECTION AND ANALYSIS: Two review authors independently collated study data. We assessed methodological quality of studies using QUADAS-2 criteria. We used a bivariate random-effects model to determine summary estimates of sensitivity and specificity where meta-analysis was possible. We performed sensitivity analyses to validate the robustness of outcomes. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included nine studies (1161 participants). Five studies included only adults. Four studies included both adults and children; however, the proportion was not reported in three of these studies. The youngest child reported in the studies was aged 13 years. There was no study including only children. The reference standard was pleocytosis in eight studies, and the combination of pleocytosis and increased protein in the cerebrospinal fluid in one study. Two studies also used smear or positive culture of cerebrospinal fluid. Risk of bias and concern about applicability was high in the participant selection domain for all included studies and the consciousness subgroup. Overall, pooled sensitivity was 65.3% (95% confidence interval (CI) 37.3 to 85.6), and pooled specificity was 70.4% (95% CI 47.7 to 86.1) (very low-certainty evidence). We established the possibility of heterogeneity from visual inspection of forest plots. However, we were unable to conduct further analysis for study population, types of meningitis, and participants' condition, other than disturbance of consciousness (a secondary outcome). Amongst participants whose consciousness was undisturbed (8 studies, 921 participants), pooled sensitivity and specificity were 75.2% (95% CI 54.3 to 88.6) and 60.8% (95% CI 43.4 to 75.9), respectively (very low-certainty evidence). AUTHORS' CONCLUSIONS: Jolt accentuation for headache may exclude diagnoses of meningitis in emergency settings, but high-quality evidence to support use of this test is lacking. Even where jolt accentuation of headache is negative, there is still the possibility of acute meningitis. This review identified the possibility of heterogeneity. However, factors that contribute to heterogeneity are incompletely understood, and should be considered in future research.


Asunto(s)
Movimientos de la Cabeza/fisiología , Cefalea/etiología , Meningitis/diagnóstico , Examen Físico/métodos , Enfermedad Aguda , Adolescente , Adulto , Sesgo , Intervalos de Confianza , Vías Clínicas , Progresión de la Enfermedad , Urgencias Médicas , Reacciones Falso Negativas , Reacciones Falso Positivas , Cefalea/líquido cefalorraquídeo , Humanos , Leucocitosis/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Meningitis/complicaciones , Rotación , Sensibilidad y Especificidad
11.
Rinsho Shinkeigaku ; 60(7): 500-503, 2020 Jul 31.
Artículo en Japonés | MEDLINE | ID: mdl-32536662

RESUMEN

A 66-year-old woman presented with dysesthesia over the right side of her face, hypoglossal nerve dysfunction, dysphagia, and dysgeusia of the right side. A MRI scan of the brain revealed cerebral dural thickening on the right side of the skull base, and histopathological examination revealed granulomatous inflammation of the dura. Based on paranasal sinusitis, bronchodilatation, laboratory tests showing weakly positive MPO-ANCA, intact renal function, and the patient's favorable response to steroids, we diagnosed the patient with limited granulomatosis with polyangiitis (GPA). Reportedly, autoimmune disease might occur in patients with exacerbation of monoclonal gammopathy of undetermined significance, which was observed in this case. This suggests the utility of immunoelectrophoresis.


Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico , Meningitis/diagnóstico , Meningitis/etiología , Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Gammopatía Monoclonal de Relevancia Indeterminada/diagnóstico , Peroxidasa/inmunología , Anciano , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Progresión de la Enfermedad , Femenino , Granulomatosis con Poliangitis/tratamiento farmacológico , Granulomatosis con Poliangitis/patología , Humanos , Hipertrofia , Meningitis/tratamiento farmacológico , Meningitis/patología , Metilprednisolona/administración & dosificación , Gammopatía Monoclonal de Relevancia Indeterminada/tratamiento farmacológico , Gammopatía Monoclonal de Relevancia Indeterminada/patología , Prednisolona/administración & dosificación , Resultado del Tratamiento
12.
Saudi Med J ; 41(6): 602-606, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32518926

RESUMEN

OBJECTIVES: To provide more data regarding the role of an amperometric glucometer in diagnosing meningitis. Methods: This is a prospective study conducted at the Pediatric and Neonatology Department, Qatif Central Hospital, Qatif, Saudi Arabia between March 2017 and September 2018. We measured glucose concentrations in cerebrospinal fluid (CSF) and blood using a central laboratory and amperometric glucometer (AG). We compared CSF/blood glucose ratios obtained in a central laboratory from clinical bedside examination with a glucometer, and calculated the sensitivity and specificity for detecting cases of meningitis. Results: A total of 101 patients with clinical suspicion of meningitis were recruited for CSF sampling. Of 101 CSF samples, 61 (60%) were suggestive of meningitis. Of 101 samples, 47 had hypoglycorrhachia identified by a standard laboratory, and 17% of them were also detected by AG. The correlation between CSF/blood glucose by AG and laboratory ratios was substantial (r=0.894, p  less than 0.01, 95% CI: 0.805-0.983). The AG sensitivity was 100% and specificity was 55% in pediatric cases, while in neonates the sensitivity was 86% and the specificity was 26%. Conclusion: Amperometric glucometers  can be used to detect hypoglycorrhachia accurately. This  point-of-care testing tool is easily accessible and can be used by health care providers for cases suspected of meningitis.


Asunto(s)
Pruebas de Química Clínica/métodos , Glucosa/líquido cefalorraquídeo , Meningitis/diagnóstico , Pruebas en el Punto de Atención , Adolescente , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Glucemia , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Sensibilidad y Especificidad
13.
Saudi Med J ; 41(6): 652-656, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32518934

RESUMEN

Immunoglobulin G4-related disease (IgG4-RD) is rare disease entity and has recently been recognized as an inflammatory disorder with the tendency to affect multiple organs. Pachymeningitis of spine caused by IgG4-related disease is extremely rare. Neck pain and spinal cord compression symptoms consist of usual presentation of IgG4-related spinal pachymeningitis; however, polyarthritis is an unusual presentation of this disease, and it was reported in only one case that mimicked psoriatic arthritis. In this report, we describe a case of IgG4-related spinal pachymeningitis in a middle-age male who presented initially with neck pain and  rheumatoid arthritis-like symptoms and later on developed both right upper and lower limb weakness. He was found to had pachymeningeal thickening on a cervical magnetic resonance image (MRI) and elevated serum IgG4 levels. He was treated with glucocorticoids and rituximab, which led to a significantly positive radiological response.


Asunto(s)
Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Meningitis/etiología , Adulto , Artritis Reumatoide/etiología , Biomarcadores/sangre , Vértebras Cervicales , Extremidades , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulina G/sangre , Imagen por Resonancia Magnética , Masculino , Meningitis/diagnóstico , Meningitis/tratamiento farmacológico , Debilidad Muscular/etiología , Dolor de Cuello/etiología , Rituximab/uso terapéutico , Compresión de la Médula Espinal/etiología , Resultado del Tratamiento
14.
Int J Infect Dis ; 97: 177-179, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32502661

RESUMEN

Next-generation sequencing (NGS) is an emerging method with the potential of pan-pathogen screening. This study described a case of eosinophilic meningitis (EoM) with enzyme-linked immunosorbent assay (ELISA)-negative results for Angiostrongylus cantonensis (A. cantonensis), Trichinella spiralis and Paragonimus westermani and a positive identification of A. cantonensis by NGS in the cerebrospinal fluid.


Asunto(s)
Angiostrongylus cantonensis , Secuenciación de Nucleótidos de Alto Rendimiento , Meningitis/diagnóstico , Infecciones por Strongylida/diagnóstico , Animales , Ensayo de Inmunoadsorción Enzimática , Eosinofilia/parasitología , Humanos , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/parasitología , Infecciones por Strongylida/líquido cefalorraquídeo , Infecciones por Strongylida/parasitología
15.
Arch. argent. pediatr ; 118(3): e309-e312, jun. 2020.
Artículo en Español | LILACS, BINACIS | ID: biblio-1116997

RESUMEN

La meningitis por estreptococo beta hemolítico, en particular del grupo A, o Streptococcus pyogenes, es una rara localización del grupo de infecciones invasivas por este microorganismo. Se presenta con frecuencia en niños sanos, sin factores predisponentes. Representa el 0,2-1 % de todas las meningitis. Generalmente, se instala por diseminación de la infección de un foco cercano. El agregado de clindamicina mejora la eficacia del tratamiento por su acción de inhibición de la síntesis proteica, que incluye la producción de toxina. La clindamicina incrementa la acción bactericida al actuar sobre el ribosoma bacteriano. La patogenia de la enfermedad no es clara; se propuso la asociación con exotoxinas. La coinfección con el virus influenza favorecería infecciones invasivas. Se presenta el caso de un niño de 6 años de edad previamente sano con diagnóstico de meningitis por estreptococo beta hemolítico del grupo A, localización poco frecuente en niños.


Beta hemolytic particularly of group A Streptococcus meningitis, is a rare site of the group of invasive infections caused by this microorganism. It occurs frequently in healthy children, without predisposing factors. It represents 0.2-1 % of all meningitis. It is usually installed by dissemination from a nearby focus. The addition of clindamycin improves the treatment efficacy by inhibition of bacterial protein synthesis, including toxin production. The pathogenesis of the disease is not clear, the association with exotoxins was proposed. Co-infection with the influenza virus would favor invasive infections. We present this case of a previously healthy 6-year-old boy with a diagnosis of beta hemolytic Streptococcus meningitis group A, a rare location in children.


Asunto(s)
Humanos , Masculino , Niño , Meningitis/diagnóstico , Streptococcus pyogenes , Clindamicina/uso terapéutico , Antibacterianos/uso terapéutico
16.
Rinsho Shinkeigaku ; 60(6): 429-433, 2020 Jun 06.
Artículo en Japonés | MEDLINE | ID: mdl-32435045

RESUMEN

We report a case of rheumatoid meningitis complicated with cryptococcal meningitis in a 59-year-old female with rheumatoid arthritis. Migraine symptoms were followed by abnormal behavior, and the patient was admitted with fever and headache. On admission, her cerebrospinal fluid (CSF) contained 115 cells/µl, a protein content of 95 mg/dl, and a sugar level of 47 mg/dl; Her serum anti-cyclic citrullinated peptide (CCP) antibody value was high (174 U/ml), and a brain MRI showed enhanced gadolinium lesions in the cerebral/cerebellar pia mater and subarachnoid space, etc. Probable rheumatoid meningitis was clinically diagnosed, and a prednisolone (PSL) pulse was started. Several days later, a CSF culture test was positive for Cryptococcus neoformans, and the antigen titer was 128-fold. Liposomal-amphotericin B (L-AMB) was started for cryptococcal meningitis, combined with three PSL pulses for rheumatoid meningitis. After about 4 weeks, the number of CSF cells and anti-CCP antibodies decreased rapidly. At 2 months after the onset, the meningitis recurred. The MRI contrast lesions reappeared, and the CSF cells increased to 24/µl. Serum and CSF anti-CCP antibodies increased at the time of recurrence, but the cryptococcal antigen titer decreased. Thus, we concluded that the rheumatoid meningitis mainly involved the pathogenesis of both types of meningitis. The number of PSL pulses was limited to four. Post-perioral therapy was avoided. Methotrexate was continued for the rheumatoid meningitis, fluconazole was continued for the cryptococcal meningitis, and neither type of meningitis has recurred.


Asunto(s)
Artritis Reumatoide/complicaciones , Meningitis Criptocócica/diagnóstico , Meningitis Criptocócica/etiología , Meningitis/diagnóstico , Meningitis/etiología , Anticuerpos/sangre , Anticuerpos/líquido cefalorraquídeo , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Meningitis/tratamiento farmacológico , Meningitis Criptocócica/tratamiento farmacológico , Metotrexato/administración & dosificación , Persona de Mediana Edad , Péptidos Cíclicos/inmunología , Prednisolona/administración & dosificación , Resultado del Tratamiento
17.
J Neurovirol ; 26(2): 143-148, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32447630

RESUMEN

A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Encefalitis Viral/epidemiología , Meningitis/epidemiología , Pandemias , Neumonía Viral/epidemiología , Accidente Cerebrovascular/epidemiología , Betacoronavirus/genética , Betacoronavirus/metabolismo , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico , Encefalitis Viral/virología , Cefalea/complicaciones , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/virología , Interacciones Huésped-Patógeno/genética , Humanos , Meningitis/complicaciones , Meningitis/diagnóstico , Meningitis/virología , Mialgia/complicaciones , Mialgia/diagnóstico , Mialgia/epidemiología , Mialgia/virología , Miositis/complicaciones , Miositis/diagnóstico , Miositis/epidemiología , Miositis/virología , Sistema Nervioso/patología , Sistema Nervioso/virología , Peptidil-Dipeptidasa A/genética , Peptidil-Dipeptidasa A/metabolismo , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Unión Proteica , Receptores Virales/genética , Receptores Virales/metabolismo , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/metabolismo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/virología , Internalización del Virus
18.
J Pediatr ; 223: 204-206.e1, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32417077

RESUMEN

We used the FilmArray meningitis/encephalitis panel for evaluation of sepsis in febrile neonates. We detected human herpesvirus 6, a virus we did not routinely test for previously, in the cerebrospinal fluid of 7 neonates. In all 7 cases, detection of the virus did not warrant antiviral treatment.


Asunto(s)
ADN Viral/análisis , Encefalitis/complicaciones , Herpesvirus Humano 6/genética , Meningitis/diagnóstico , Infecciones por Roseolovirus/diagnóstico , Sepsis/virología , Centros de Atención Terciaria , Encefalitis/diagnóstico , Encefalitis/virología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/complicaciones , Reacción en Cadena de la Polimerasa Multiplex , Infecciones por Roseolovirus/complicaciones , Infecciones por Roseolovirus/virología , Sepsis/diagnóstico , Sepsis/etiología
19.
Am J Trop Med Hyg ; 103(2): 696-703, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32458777

RESUMEN

Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pathogens in central nervous system infections is poorly characterized. Cerebrospinal fluid (CSF) specimens were collected from children younger than 5 years with suspected meningitis, presenting at pediatric teaching hospitals across West Africa in five countries including Senegal, Ghana, Togo, Nigeria, and Niger. Cerebrospinal fluid specimens were initially tested using bacteriologic culture and a triplex real-time polymerase chain reaction (PCR) assay for N. meningitidis, S. pneumoniae, and H. influenzae used in routine meningitis surveillance. A custom TaqMan Array Card (TAC) assay was later used to detect 35 pathogens including 15 bacteria, 17 viruses, one fungus, and two protozoans. Among 711 CSF specimens tested, the pathogen positivity rates were 2% and 20% by the triplex real-time PCR (three pathogens) and TAC (35 pathogens), respectively. TAC detected 10 bacterial pathogens, eight viral pathogens, and Plasmodium. Overall, Escherichia coli was the most prevalent (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%). Multiple pathogens were detected in 4.4% of the specimens. Children with human immunodeficiency virus (HIV) and Plasmodium detected in CSF had high mortality. Among 220 neonates, 17% had at least one pathogen detected, dominated by gram-negative bacteria. The meningitis TAC enhanced the detection of pathogens in children with meningitis and may be useful for case-based meningitis surveillance.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Malaria Cerebral/epidemiología , Meningitis Neumocócica/epidemiología , Meningitis/epidemiología , Meningitis/microbiología , África Occidental/epidemiología , Preescolar , Técnicas de Cultivo , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Infecciones por Escherichia coli/líquido cefalorraquídeo , Infecciones por Escherichia coli/diagnóstico , Femenino , Ghana/epidemiología , Infecciones por VIH/líquido cefalorraquídeo , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Vacunas contra Haemophilus/uso terapéutico , Humanos , Lactante , Recién Nacido , Infecciones por Klebsiella/líquido cefalorraquídeo , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/epidemiología , Malaria Cerebral/líquido cefalorraquídeo , Malaria Cerebral/diagnóstico , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis por Haemophilus/líquido cefalorraquídeo , Meningitis por Haemophilus/epidemiología , Meningitis por Haemophilus/prevención & control , Meningitis Meningocócica/líquido cefalorraquídeo , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/prevención & control , Meningitis Neumocócica/líquido cefalorraquídeo , Meningitis Neumocócica/prevención & control , Vacunas Meningococicas/uso terapéutico , Técnicas de Diagnóstico Molecular , Mortalidad , Reacción en Cadena de la Polimerasa Multiplex , Niger/epidemiología , Nigeria/epidemiología , Vacunas Neumococicas/uso terapéutico , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones por Roseolovirus/líquido cefalorraquídeo , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/epidemiología , Senegal/epidemiología , Infecciones Estafilocócicas/líquido cefalorraquídeo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Togo/epidemiología
20.
BMC Infect Dis ; 20(1): 304, 2020 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-32326881

RESUMEN

BACKGROUND: Cerebrospinal fluid (CSF) analyses are recommended in patients with meningitis and/or encephalitis, but evidence regarding its diagnostic yield is low. We aimed to determine predictors of infectious pathogens in the CSF of adult patients presenting with meningitis, and/or encephalitis. METHODS: Consecutive patients with meningitis and/or encephalitis form 2011-17 at a Swiss academic medical care center were included in this cross-sectional study. Clinical, neuroradiologic, and laboratory data were collected as exposure variables. Infectious meningitis and/or encephalitis were defined as the composite outcome. For diagnosis of bacterial meningitis the recommendations of the European Society of Clinical Microbiology and Infectious Diseases were followed. Viral meningitis was diagnosed by detection of viral ribonucleic or deoxyribonucleic acid in the CSF. Infectious encephalitis was defined according to the International Encephalitis Consortium (IEC). Meningoencephalitis was diagnosed if the criteria for meningitis and encephalitis were fulfilled. Multinomial logistic regression was performed to identify predictors of the composite outcome. To quantify discriminative power, the c statistic analogous the area under the receiver-operating curve (AUROC) was calculated. An AUROC between 0.7-0.8 was defined as "good", 08-0.9 as "excellent", and > 0.9 as "outstanding". Calibration was defined as "good" if the goodness of fit tests revealed insignificant p-values. RESULTS: Among 372 patients, infections were diagnosed in 42.7% presenting as meningitis (51%), encephalitis (32%), and meningoencephalitis (17%). Most frequent infectious pathogens were Streptococcus pneumoniae, Varicella zoster, and Herpes simplex 1&2. While in multivariable analysis lactate concentrations and decreased glucose ratios were the only independent predictors of bacterial infection (AUROCs 0.780, 0.870, and 0.834 respectively), increased CSF mononuclear cells were the only predictors of viral infections (AUROC 0.669). All predictors revealed good calibration. CONCLUSIONS: Prior to microbiologic workup, CSF data may guide clinicians when infection is suspected while other laboratory and neuroradiologic characteristics seem less useful. While increased CSF lactate and decreased glucose ratio are is the most reliable predictors of bacterial infections in patients with meningitis and/or encephalitis, only mononuclear cell counts predicted viral infections. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03856528. Registered on February 26th 2019.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , Encefalitis/diagnóstico , Meningitis/diagnóstico , Adulto , Anciano , Área Bajo la Curva , Estudios Transversales , Encefalitis/microbiología , Encefalitis/virología , Femenino , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Modelos Logísticos , Masculino , Meningitis/microbiología , Meningitis/virología , Meningoencefalitis/diagnóstico , Meningoencefalitis/microbiología , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Simplexvirus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación
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