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1.
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
2.
PLoS One ; 15(12): e0244214, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33362236

RESUMEN

BACKGROUND: Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox's Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019). METHODS: Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability. RESULTS: Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability. DISCUSSION: The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox's Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Indicadores de Salud , Vigilancia en Salud Pública/métodos , Campos de Refugiados/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Bangladesh , Dengue/epidemiología , Diarrea/epidemiología , Humanos , Sarampión/epidemiología , Meningitis/epidemiología , Mianmar , Campos de Refugiados/normas , Sociedades Médicas
3.
Artículo en Inglés | MEDLINE | ID: mdl-33053146

RESUMEN

Meningoencephalitis is a syndrome of multiple etiologies associated with important morbidity and mortality. It may be caused by various infectious agents (viruses, bacteria, parasites and fungi). Establishing the etiology of meningoencephalitis is crucial for early and specific treatment. Molecular assays such as the multiplex polymerase chain reaction (PCR) offer an alternative in diagnosing central nervous system infections. This study aimed to describe the performance of an automated multiplex molecular test from patients with suspected meningitis and meningoencephalitis in a tertiary referral complex in Medellin, Colombia. Thus, a prospective study was performed in 638 cerebrospinal fluid samples from January 2017 to July 2019. Molecular detections were carried out by means of the FilmArray® Meningitis/Encephalitis (M/E) Panel from bioMérieux, France, and by conventional tests. Univariate analyses for microbiological and demographic characteristics were performed. Accuracy of the bacterial/fungal PCR assay compared to cultures was also performed. Among patients, 57.7% were male, the median age was 24 (IQR: 6 - 47) years old. The overall positivity was 15.2% (97 detections) and viruses were detected in 45.5% of the samples, bacteria in 43.5% and fungi in 10.8%. The most frequent etiological agents were: Streptococcus pneumoniae (16%), Cryptococcus neoformans/gatti (11.3%) and Herpes simplex virus (10.3%). Four double detections were found. Almost half of positive detections were in patients under 15 years old. This molecular approach is reliable and easily implantable into a laboratory routine, increasing the capacity of detection of bacterial and viral causative agents of meningitis, possibly playing a relevant role in the clinical context.


Asunto(s)
Meningitis/epidemiología , Meningoencefalitis/epidemiología , Reacción en Cadena de la Polimerasa Multiplex/métodos , Adolescente , Adulto , Niño , Colombia/epidemiología , Femenino , Humanos , Masculino , Meningitis/etiología , Meningoencefalitis/etiología , Persona de Mediana Edad , Estudios Prospectivos , Adulto Joven
4.
Glob Health Action ; 13(1): 1795963, 2020 12 31.
Artículo en Inglés | MEDLINE | ID: mdl-32762300

RESUMEN

Managing a deadly pandemic in low- and middle-income countries (LMIC) is challenging. The task becomes tougher when there is an outbreak of an equally deadly disease. This is the present situation of Ghana, a low-resource country, that is confronted with the coronavirus disease 2019 (COVID-19) pandemic and cerebrospinal meningitis (CSM) outbreak. Apart from the resource constraint at both governmental and individual levels, such a situation affects the overall wellbeing of ordinary citizens as well as healthcare professionals, particularly those in high-risk areas. Perhaps, more than ever, we have to ensure equitable distribution of scarce healthcare resources in our effort to manage this 'twin disaster' of COVID-19 and CSM. We evaluated Ghana's situation (outbreak response) and recommended measures to help us navigate this conundrum of a public health crisis.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Desastres/prevención & control , Brotes de Enfermedades/prevención & control , Meningitis/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Ghana/epidemiología , Asignación de Recursos para la Atención de Salud , Recursos en Salud/provisión & distribución , Humanos , Meningitis/epidemiología , Neumonía Viral/epidemiología
5.
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
6.
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
7.
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
9.
Diagn Microbiol Infect Dis ; 97(1): 115005, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32081521

RESUMEN

Streptococcus agalactiae is an important pathogen that causes infections in neonates and adults; infections especially in nonpregnant adults are increasing worldwide. Of 1736 S. agalactiae isolates from individuals throughout Thailand, serotypes III (46.4%) and V (21%) were demonstrated to be the most common serotypes. Human cases (56.5% female and 43.5% male) could be found all year round, with the peak occurring more frequently during the rainy season (May-October). The mortality rate of S. agalactiae infections was 11.6%, and serotype III was the most common serotype involved. Serotype III was strongly significantly (P value <0.001) correlated with meningitis (odds ratio [OR] = 26.72), sepsis (OR = 5.56), and septic arthritis (OR = 22.79). Serotype V was more associated with urinary tract infection than other serotypes. (P value = 0.005; OR = 2.32).


Asunto(s)
Serogrupo , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/epidemiología , Adolescente , Adulto , Anciano , Artritis Infecciosa/epidemiología , Artritis Infecciosa/microbiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Meningitis/epidemiología , Meningitis/microbiología , Persona de Mediana Edad , Estudios Prospectivos , Estaciones del Año , Sepsis/epidemiología , Sepsis/microbiología , Infecciones Estreptocócicas/mortalidad , Streptococcus agalactiae , Centros de Atención Terciaria/estadística & datos numéricos , Tailandia/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Adulto Joven
10.
PLoS One ; 15(2): e0228799, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053640

RESUMEN

BACKGROUND: Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV-10) in 2015. We measured population-based incidence of invasive pneumococcal disease (IPD) prior to introduction of PCV-10 to provide a benchmark against which the impact of PCV-10 can be assessed. METHODS: We conducted population, facility and laboratory-based surveillance in children 0-59 months of age in three rural sub-districts of Sylhet district of Bangladesh from January 2014 to June 2015. All children received two-monthly home visits with one week recall for morbidity and care seeking. Children attending the three Upazilla Health Complexes (UHC, sub-district hospitals) in the surveillance area were screened for suspected IPD. Blood samples were collected from suspected IPD cases for culture and additionally, cerebrospinal fluid (CSF) was collected from suspected meningitis cases for culture and molecular testing. Pneumococcal isolates were serotyped by Quellung. Serotyping of cases detected by molecular testing was done by sequential multiplex polymerase chain reaction. RESULTS: Children under surveillance contributed to 126,657 child years of observations. Sixty-three thousand three hundred eighty-four illness episodes were assessed in the UHCs. Blood specimens were collected from 8,668 suspected IPD cases and CSF from 177 suspected meningitis cases. Streptococcus pneumoniae was isolated from 46 cases; 32 (70%) were vaccine serotype. The population-based incidence of IPD was 36.3/100,000 child years of observations. About 80% of the cases occurred in children below two years of age. DISCUSSION: IPD was common in rural Bangladesh suggesting the potential benefit of an effective vaccine. Measurement of the burden of IPD requires multiple surveillance modalities.


Asunto(s)
Infecciones Neumocócicas/diagnóstico , Streptococcus pneumoniae/aislamiento & purificación , Bangladesh/epidemiología , Cultivo de Sangre , Preescolar , ADN Bacteriano/metabolismo , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Meningitis/diagnóstico , Meningitis/epidemiología , Meningitis/microbiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Serogrupo , Streptococcus pneumoniae/genética
11.
Int J Mol Sci ; 21(5)2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32106601

RESUMEN

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is a highly complex disease with very high mortality and morbidity. About one-third of SAH patients suffer from systemic infections, predominantly pneumonia, that can contribute to excess mortality after SAH. Immunodepression is probably the most important mechanism leading to infections. Interleukin-10 (IL-10) is a master regulator of immunodepression, but it is still not clear if systemic IL-10 levels contribute to immunodepression, occurrence of infections and clinical outcome after SAH. METHODS: This explorative study included 76 patients with SAH admitted to our neurointensive care unit within 24 h after ictus. A group of 24 patients without any known intracranial pathology were included as controls. Peripheral venous blood was withdrawn on day 1 and day 7 after SAH. Serum was isolated by centrifugation and stored at -80 °C until analysis. Serum IL-10 levels were determined by enzyme-linked immunoassay (ELISA). Patient characteristics, post-SAH complications and clinical outcome at discharge were retrieved from patients' record files. RESULTS: Serum IL-10 levels were significantly higher on day 1 and day 7 in SAH patients compared to controls. Serum IL-10 levels were significantly higher on day 7 in patients who developed any kind of infection, cerebral vasospasm (CVS) or chronic hydrocephalus. Serum IL-10 levels were significantly higher in SAH patients discharged with poor clinical outcome (modified Rankin Scale (mRS) 3-6 or Glasgow Outcome Scale (GOS) 1-3). CONCLUSION: Serum IL-10 might be an additional useful parameter along with other biomarkers to predict post-SAH infections.


Asunto(s)
Neumonía Asociada a la Atención Médica/sangre , Interleucina-10/sangre , Meningitis/sangre , Hemorragia Subaracnoidea/sangre , Anciano , Biomarcadores/sangre , Femenino , Neumonía Asociada a la Atención Médica/epidemiología , Neumonía Asociada a la Atención Médica/etiología , Humanos , Aneurisma Intracraneal/sangre , Aneurisma Intracraneal/complicaciones , Masculino , Meningitis/epidemiología , Meningitis/etiología , Persona de Mediana Edad , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/etiología
12.
Arch Dis Child ; 105(7): 625-630, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31959596

RESUMEN

OBJECTIVE: There are few studies on cerebral palsy (CP) in African children and our study aimed to describe the aetiology, characteristics and severity of CP in children from Nigeria. DESIGN: A population-based study using key informant methodology (KIM) was conducted as part of a clinical research trial. Children aged 4-15 years were clinically assessed for CP. RESULTS: The estimated prevalence of CP using KIM was 2.3/1000 children (95% CI 2.0 to 2.5/1000). 388 children were diagnosed with CP, with Gross Motor Function Classification System level 1 in 70 (18.1%), II in 156 (40.2%), III in 54 (13.9%), IV in 54 (13.9%), V in 54 (13.9%). 300/388 (77.3%) had Manual Ability Classification Scale of level 1-3 and 88 (22.7%) of level 4-5. CP types were spastic in 271 (70%), with 60% of these bilateral and 40% unilateral, ataxic 38 (9.8%), dystonic 18 (4.6%), choreoathetoid 29 (7.5%) and unclassifiable 32 (8.3%). Postneonatal risk factors for CP were seen in 140 (36.1%) children including malaria with seizures 101/140 (72.1%), malaria with coma 21/140 (15.0%), meningitis 12/140 (8.6%), tuberculosis 2/140 (1.4%), sickle cell disease 3/140 (2.2%), HIV 1/221 (0.7%). Prenatal/perinatal risk factors were seen in 248 (63.9%%), birth asphyxia 118 (47.6%) and clinical congenital rubella syndrome 8 (3.3%) and hyperbilirubinaemia 59 (23.8%) were identified as preventable risk factors for CP. CONCLUSION: The profile of CP in this population is similar to that found in other low-income and middle-income countries (LMIC). Some risk factors identified were preventable. Prevention and management strategies for CP designed for LMIC are needed.


Asunto(s)
Parálisis Cerebral/epidemiología , Parálisis Cerebral/etiología , Países en Desarrollo/estadística & datos numéricos , Adolescente , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/epidemiología , Traumatismos del Nacimiento/complicaciones , Traumatismos del Nacimiento/epidemiología , Parálisis Cerebral/clasificación , Niño , Preescolar , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Hiperbilirrubinemia/complicaciones , Hiperbilirrubinemia/epidemiología , Malaria/complicaciones , Malaria/epidemiología , Masculino , Meningitis/complicaciones , Meningitis/epidemiología , Nigeria/epidemiología , Oportunidad Relativa , Prevalencia , Síndrome de Rubéola Congénita/complicaciones , Síndrome de Rubéola Congénita/epidemiología , Índice de Severidad de la Enfermedad , Tuberculosis/complicaciones , Tuberculosis/epidemiología
13.
Int J Infect Dis ; 93: 28-39, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31972289

RESUMEN

OBJECTIVES: To describe and analyse the epidemiological and clinical characteristics of imported human angiostrongyliasis in Europe. METHODS: A systematic literature review of cases of human angiostrongyliasis in Europe was performed. Seven databases were searched. The epidemiological and clinical characteristics were extracted from included records and simple summary statistics were performed on extracted data. RESULTS: Twenty-two cases reported between 1988 and 2019 were identified. They were mainly from French Polynesia, Southeast Asia, and the Caribbean Islands. The dominant suspected mode of transmission was ingestion of prawns, shrimp, or salad. For patients with data, 90% had a history of headache, often lasting, and half had paresthesia. Eighty-nine percent had eosinophilia, 93% had cerebrospinal fluid (CSF) eosinophilia, and 92% had elevated CSF protein. Central nervous system (CNS) imaging was normal in most cases. Two-thirds received albendazole or mebendazole treatment, although this is not currently recommended. CONCLUSIONS: We have increased previous numbers to 22 reported cases in total since 1988. Angiostrongyliasis should generally be suspected in patients with a lasting headache who have returned from Southeast Asia, China, the Caribbean Islands, Australia, or French Polynesia, as well as parts of North America and Tenerife, Spain, although one autochthonous case from mainland Europe has also been reported. A dietary history should focus on prawns, shrimp, and salad, whilst also including slugs and snails and other paratenic hosts where relevant. The clinical diagnosis is supported by the presence of blood eosinophilia, CSF eosinophilia, and elevated CSF protein. A definitive laboratory diagnosis should be sought, and CNS imaging should be used to support, not to rule out the diagnosis. The most up-to-date evidence should always be consulted before initiating treatment. Current recommendations include analgesics, corticosteroids, and periodic removal of CSF for symptom relief, while antihelminthic treatment is debated.


Asunto(s)
Angiostrongylus cantonensis , Eosinofilia/parasitología , Meningitis/parasitología , Infecciones por Strongylida/diagnóstico , Infecciones por Strongylida/epidemiología , Adolescente , Adulto , Animales , Asia Sudoriental , Australia , Eosinofilia/diagnóstico , Eosinofilia/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Lactante , Masculino , Meningitis/diagnóstico , Meningitis/epidemiología , Persona de Mediana Edad , Polinesia , Alimentos Marinos , Caracoles , Infecciones por Strongylida/complicaciones , Infecciones por Strongylida/transmisión , Indias Occidentales
14.
Int J Infect Dis ; 93: 133-138, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31982623

RESUMEN

BACKGROUND: Strongyloidiasis is a devastating disease with a mortality rate exceeding 50% in immunocompromised patients. The disease usually results from reactivation of a latent infection in a transplant patient. Alternatively, donor-derived transmission of Strongyloides may occur. METHODS: In this review, we report a case of Strongyloides hyperinfection syndrome in a liver transplant recipient to illustrate the severity of this infection. Following this, PubMed was searched for cases of transplant-related strongyloidiasis in the Gulf Cooperation Council (GCC) countries. Demographic data, the clinical presentation of recipients, and donor information were recorded. Methods of diagnosis, treatment planning, and clinical outcomes were documented. RESULTS: A total of 12 transplant-related strongyloidiasis cases were identified. Seventy-five percent of the patients were from Saudi Arabia. Three cases from Kuwait shared common donors. All donors were deceased and native to an area endemic for Strongyloides. Five of the patients shared common donors, raising the possibility of donor-derived infection. Neither the donors nor the recipients underwent screening tests for Strongyloides. Concomitant bacteremia and/or meningitis was seen in 50% of cases (6/12). Moreover, when documented, sepsis was detected in all of the patients who died (three cases). The mortality rate in this series was high (41.7%). CONCLUSIONS: Since this is a preventable condition, early diagnosis and treatment is essential. The screening and treatment of potential transplant recipients and donors proved to be an effective preventive measure. There is a growing need for further studies and implementation of screening policies in the GCC countries to prevent this fatal infection.


Asunto(s)
Trasplante de Órganos/efectos adversos , Estrongiloidiasis/etiología , Adolescente , Adulto , Animales , Bacteriemia/complicaciones , Bacteriemia/epidemiología , Niño , Femenino , Humanos , Kuwait , Trasplante de Hígado/efectos adversos , Masculino , Meningitis/complicaciones , Meningitis/epidemiología , Persona de Mediana Edad , Arabia Saudita , Sepsis/complicaciones , Sepsis/epidemiología , Estrongiloidiasis/complicaciones , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/microbiología , Síndrome , Donantes de Tejidos , Receptores de Trasplantes , Adulto Joven
15.
Pediatr Infect Dis J ; 39(1): 35-40, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31738319

RESUMEN

BACKGROUND: Sepsis and meningitis in neonates and infants are a source of substantial morbidity, mortality and economic loss. The objective of this review is to estimate the acute costs associated with treating sepsis, meningitis and meningococcal septicemia, in neonates and infants, worldwide. METHODS: The electronic databases Medline, Embase and EconLit were searched and exported on November 24, 2018. Studies that reported an average hospitalization cost for confirmed cases of sepsis, meningitis or meningococcal septicemia were eligible for our review. Descriptive data were extracted and reported costs were inflated and converted. A narrative synthesis of the costs was conducted. RESULTS: Our review identified 20 studies reporting costs of sepsis, meningitis and/or meningococcal septicemia. Costs ranged from $55 to $129,632 for sepsis and from $222 to $33,635 for meningitis (in 2017 US dollars). One study estimated the cost of meningococcal septicemia to be $56,286. All reported costs were estimated from the perspective of the healthcare provider or payer. Most studies were from the United States, which also had the highest costs. Only a few studies were identified for low- and middle-income countries, which reported lower costs than high-income countries for both sepsis and meningitis. CONCLUSIONS: Sepsis and meningitis in neonates and infants are associated with substantial costs to the healthcare system and showed a marked difference across global income groups. However, more research is needed to inform costs in low- and middle-income settings and to understand the economic costs borne by families and wider society.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud , Meningitis/epidemiología , Sepsis/epidemiología , Comorbilidad , Femenino , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/etiología , Sepsis/etiología
16.
World Neurosurg ; 134: e1115-e1120, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31785439

RESUMEN

BACKGROUND: The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate. METHODS: A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius. RESULTS: Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P = 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P = 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P = 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak. CONCLUSIONS: Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater.


Asunto(s)
Materiales Biocompatibles/uso terapéutico , Duramadre/cirugía , Fascia/trasplante , Neoplasias Infratentoriales/cirugía , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Reconstructivos/métodos , Adolescente , Adulto , Anciano , Astrocitoma/cirugía , Neoplasias del Tronco Encefálico/cirugía , Neoplasias Cerebelosas/cirugía , Neoplasias del Ventrículo Cerebral/cirugía , Pérdida de Líquido Cefalorraquídeo/epidemiología , Niño , Preescolar , Ependimoma/cirugía , Femenino , Cuarto Ventrículo , Hemangioblastoma/cirugía , Hemangioma Cavernoso del Sistema Nervioso Central/cirugía , Humanos , Lactante , Masculino , Meduloblastoma/cirugía , Meningioma/cirugía , Meningitis/epidemiología , Meningocele/epidemiología , Persona de Mediana Edad , Cuello , Estudios Retrospectivos , Trasplante Autólogo , Adulto Joven
17.
J Microbiol Immunol Infect ; 53(2): 307-314, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29934034

RESUMEN

BACKGROUND/PURPOSE: The clinical, epidemiological, and laboratory factors associated with disease severity and mortality from confirmed leptospirosis patients in Taiwan are not well known. This retrospective study examined patients with suspected leptospirosis admitted to En-Chu-Kong Hospital, a regional teaching hospital in northern Taiwan. METHODS: From January 2002 to July 2014, 733 suspected cases were reported to the National Reference Laboratory, 57 of which were identified as laboratory and clinical confirmed. We analyzed the clinical, epidemiological, and laboratory factors associated with disease severity and mortality in 57 cases. RESULTS: The mean age was 59.1 ± 18.2 years, 74% were male, and 49% had occupational contact with soil. The major complications were pulmonary involvement (54%), shock (44%), ventilator support (32%), jaundice (32%), hemorrhage (30%), acute kidney injury (30%), meningitis (11%) and myocarditis (2%). Leptospira santarosai serova Shermani was present in 42 (74%) patients and 37 (58%) patients had severe leptospirosis. Sixteen (28%) patients had concomitant infections, including nine patients with bloodstream infection. The only independent predictor for severe leptospirosis was shock (OR 14.8, 95% CI 2.97-73.59). Eleven patients died (19%). Acute respiratory distress syndrome with severe pulmonary hemorrhage syndrome (6 patients) was present in 55% of the fatal cases. The factors independently related to mortality were prior steroid use (OR 20.2, 95% CI 1.9-217.5) and hemorrhage (OR 71.2, 95% CI 4.9 - >999.9). CONCLUSION: These results indicate that shock is a predictor of severe leptospirosis, and prior steroid use and hemorrhage are predictors of death from leptospirosis.


Asunto(s)
Leptospirosis/complicaciones , Leptospirosis/mortalidad , Índice de Severidad de la Enfermedad , Lesión Renal Aguda , Adulto , Anciano , Femenino , Hemorragia/complicaciones , Hemorragia/epidemiología , Hospitales de Enseñanza , Humanos , Ictericia/complicaciones , Ictericia/epidemiología , Leptospira , Leptospirosis/fisiopatología , Modelos Logísticos , Pulmón , Masculino , Meningitis/complicaciones , Meningitis/epidemiología , Persona de Mediana Edad , Miocarditis/complicaciones , Miocarditis/epidemiología , /epidemiología , Estudios Retrospectivos , Factores de Riesgo , Choque/complicaciones , Choque/epidemiología , Taiwán/epidemiología , Ventiladores Mecánicos
19.
Emerg Microbes Infect ; 8(1): 1438-1444, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31571527

RESUMEN

During 2014, enterovirus D68 (EV-D68) outbreaks were described globally, causing severe respiratory diseases in children and, in some cases, subsequent paralysis. In this study, the type characterization of enterovirus (EV) detected in respiratory illnesses and the epidemiology and clinical association of EV-D68 infections in Spain over a five-year period were described. A total of 546 EV-positive samples from hospitalized patients with respiratory infections were included. EV-D68 was the most frequently detected type (46.6%, 191/410 typed EV). Other EV from species A (25.1%), B (27.8%) and C (0.5%) were also identified. EV-D68 infections were more associated with bronchitis while EV-A/B types were more frequent in upper respiratory illness (p < 0.01). EV-D68 was also detected in patients with neurological symptoms (nine meningitis/meningoencephalitis and eight acute flaccid paralysis cases). Phylogenetic analysis of 3'-VP1 region showed most Spanish EV-D68 sequences from 2014 to 2016 belonged to subclades B2/B3, as other American and European strains circulating during the same period. However, those detected in 2017 and 2018 clustered to the emerged subclade D1. In summary, different EV can cause respiratory infections but EV-D68 was the most prevalent, with several strains circulating in Spain at least since 2014. Association between EV-D68 infection and neurological disease was also described.


Asunto(s)
Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/virología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Adulto , Anciano , Anciano de 80 o más Años , Bronquitis/epidemiología , Bronquitis/virología , Preescolar , Enterovirus Humano D/clasificación , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Meningitis/epidemiología , Meningitis/virología , Persona de Mediana Edad , Parálisis/epidemiología , Parálisis/virología , Filogenia , España/epidemiología
20.
J Neurol ; 266(12): 3065-3075, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31520105

RESUMEN

INTRODUCTION: Predisposing and precipitating factors for delirium are well known; however, their interaction and impact on delirium in neurological patients remains largely unknown. Therefore, those factors were evaluated in hospitalized patients with neurological disorders. METHODS: In this prospective cohort study, 1487 neurological patients were included, 356 patients with delirium and 1131 without delirium. Relevant neurological- and medical-related clusters were assessed with multiple regression analyses, prediction models, and cluster analysis evaluating their association with delirium. RESULTS: The 1-year incidence of delirium in this cohort was 23.9%. Delirium developed in 31% of patients with stroke, in 39.5% with epilepsy, and in 58.4% with ICH. The most relevant predisposing factors were substance-use disorders (OR 4.24, 2.28-7.78, p < 0.001), advanced age (OR 3.44, CI 2.40-4.92, p < 0.001), and neurodegenerative disorders (OR 2.58, CI 1.47-4.54, p = 0.001). The most relevant precipitating factors were meningitis (OR 21.52, CI 1.22-379.83, p = 0.036), acute renal failure (OR 10.01, CI 1.13-88.73, p = 0.039), and intracranial hemorrhage (OR 3.62, CI 2.08-6.30, p < 0.001). Delirious patients were hospitalized 6 days longer, had higher in-hospital mortality, and were discharged more often to nursing homes and rehabilitation. Best predictor for delirium was the coexistence of advanced age with epilepsy (58.3%, p < 0.001), while patients aged < 65 years without epilepsy and stroke rarely developed delirium (5.1%, p < 0.001). CONCLUSIONS: Delirium is common in elder neurological patients and associated with worse outcome. Primary cerebral conditions most frequently precipitate delirium in neurology. Neurologists are advised to monitor symptoms of delirium in the presence of risk factors to enable both timely diagnostic work-up and management of delirium.


Asunto(s)
Lesión Renal Aguda/epidemiología , Delirio/epidemiología , Delirio/etiología , Epilepsia/epidemiología , Hemorragias Intracraneales/epidemiología , Meningitis/epidemiología , Accidente Cerebrovascular/epidemiología , Factores de Edad , Anciano , Análisis por Conglomerados , Comorbilidad , Susceptibilidad a Enfermedades , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Neurodegenerativas/epidemiología , Factores Desencadenantes , Estudios Prospectivos , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología
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