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1.
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
2.
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
3.
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
4.
BMC Infect Dis ; 20(1): 170, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087681

RESUMEN

BACKGROUND: Infectious meningitis is a serious disease and patient outcome relies on fast and reliable diagnostics. A syndromic panel testing approach like the FilmArray ME can accelerate diagnosis and therefore decrease the time to pathogen specific therapy. Yet, its clinical utility is controversial, mainly because of a remaining uncertainty in correct interpretation of results, limited data on its performance on clinical specimens and its relatively high costs. The aim of this study was to analyze clinical performance of the assay in a real life setting at a tertiary university hospital using a pragmatic and simple sample selection strategy to reduce the overall cost burden. METHODS: Over a period of 18 months we received 4623 CSF samples (2338 hospitalizations, 1601 individuals). FilmArray ME analysis was restricted to CSF-samples with a high pretest probability of infectious meningitis, e.g. positive Gram-stain, samples in which leukocytes and/or bacteria were evident or urgent suspicion of infection was communicated by clinicians. N = 171 samples matched to our risk criteria and were subjected to FilmArray ME analysis. Those samples were also analyzed by reference methods: culture only (n = 45), PCR only (n = 20) or both methods (n = 106). RESULTS: 56/171 (32.75%) were FilmArray ME positive. Bacterial pathogens were detected in 30/56 (53.57%), viral pathogens were detected in 27/56 (48.21%) and yeast DNA was detected in 1/56 (1.79%) of positive samples. Double detection occurred in 2/56 samples. In 52/56 (92.86%) FilmArray ME positive samples, results could be confirmed by the reference assays (sensitivity = 96.30%, specificity =96.58%). CONCLUSION: The FilmArray ME assay is a fast and reliable diagnostic tool for the management of infectious meningitis and can easily be implemented in routine diagnostic workflows. However, correlation of test results and underlying clinical symptoms requires experienced users and the awareness of potentially false negative or false positive results. Moreover, considering the need for antimicrobial susceptibility testing, the use of molecular tests as a stand-alone diagnostic cannot be recommended.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Encefalitis/diagnóstico , Meningitis/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Reacción en Cadena de la Polimerasa Multiplex/métodos , Coloración y Etiquetado/métodos , Pruebas Diagnósticas de Rutina/economía , Encefalitis/líquido cefalorraquídeo , Encefalitis/microbiología , Encefalitis/virología , Violeta de Genciana , Alemania , Hospitales Universitarios , Humanos , Laboratorios , Meningitis/líquido cefalorraquídeo , Meningitis/microbiología , Meningitis/virología , Técnicas de Diagnóstico Molecular/economía , Reacción en Cadena de la Polimerasa Multiplex/economía , Fenazinas , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Coloración y Etiquetado/economía , Centros de Atención Terciaria
5.
J Microbiol Immunol Infect ; 53(2): 216-224, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30448438

RESUMEN

BACKGROUND: There has been a great deal of evidence indicating that cytokines participate in meningeal inflammation. Different cytokine profiles may be presented in central nervous system (CNS) infection due to different pathogens. We have attempted to investigate cytokine profiles in cerebrospinal fluid (CSF) of patients with CNS infection. METHODS: Forty-three patients with CNS infection including tuberculous meningitis, purulent meningitis and cryptococcal meningitis were enrolled and 11 patients with normal CSF were enrolled as control group. The concentrations of Th1-, Th2- and Th17-type cytokines in CSF were detected using multiplex cytokine assay. Furthermore, the correlation between CSF cytokines and CSF parameters in CNS infection was analyzed. RESULTS: The CSF levels of IL-1ß, IL-4, IL-6, IL-10, IL-17, IL-23, IL-33, IFN-γ, TNF-α and sCD40L among the patients with CNS infection were all higher than control group (all P < 0.05). A remarkable elevation of CSF IL-6 in the patients with CNS infection was observed with the least overlap of the CSF concentrations compared to controls. Moreover, CSF IL-6 levels were strongly negatively correlated with CSF glucose and the CSF/blood glucose ratio (r = -0.4375, P = 0.0042; r = -0.4991, P = 0.0009). CONCLUSIONS: The excessive activation of immune response characterized by elevated levels of CSF Th1-, Th2- and Th17-type cytokines has been observed during CNS infection. Furthermore, we observed negative correlations between CSF IL-6 levels and CSF glucose and CSF/blood glucose ratio in CNS infection. And we suggested that combined CSF IL-6 levels with CSF glucose may serve as a novel biomarker pool for the differential of CNS infection.


Asunto(s)
Citocinas/líquido cefalorraquídeo , Hospitales Generales , Meningitis/líquido cefalorraquídeo , Centros de Atención Terciaria , Adulto , Anciano , Biomarcadores/líquido cefalorraquídeo , Glucemia , Líquido Cefalorraquídeo/química , China , Cryptococcus neoformans , Citocinas/metabolismo , Femenino , Glucosa , Humanos , Interleucina-6/líquido cefalorraquídeo , Masculino , Meningitis/diagnóstico , Meningitis/microbiología , Meningitis Criptocócica , Persona de Mediana Edad , Células TH1 , Células Th17 , Células Th2 , Adulto Joven
6.
BMC Infect Dis ; 19(1): 692, 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31382892

RESUMEN

BACKGROUND: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject. METHODS: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. RESULTS: A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. In addition to bacteremia, concomitant sources of infection occurred in 17 cases. CONCLUSIONS: Meningitis in the absence of pleocytosis on CSF is rare. If this occurs, causative organism is likely bacterial. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture.


Asunto(s)
Leucocitosis/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Cultivo de Sangre , Líquido Cefalorraquídeo/microbiología , Líquido Cefalorraquídeo/virología , Pruebas Diagnósticas de Rutina , Humanos , Recuento de Leucocitos , Meningitis/sangre , Meningitis/mortalidad , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Punción Espinal
7.
BMJ Case Rep ; 12(8)2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31444262

RESUMEN

A 65-year-old woman with long-standing rheumatoid arthritis (RA) experienced a recurrent tingling sensation in her left arm followed by aphasia and a tingling sensation in her right arm. A subsequent imaging study showed bilateral subdural fluid accumulation and we initially diagnosed her with a transient ischaemic attack and chronic subdural haematoma (CSDH). The cerebral spinal fluid study revealed an inflammatory response without any indications of infection or malignant tumours. After a meningeal biopsy, we redefined the diagnosis to rheumatoid meningitis (RM), and the patient showed remarkable improvement with prednisolone administration. RM should be considered as an alternative diagnosis when examining central nervous system diseases in patients with RA, as RM presents a highly variable clinical picture with image findings similar to those of CSDH.


Asunto(s)
Artritis Reumatoide/diagnóstico , Meningitis/diagnóstico , Anciano , Afasia/etiología , Artritis Reumatoide/líquido cefalorraquídeo , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Hematoma Subdural Crónico , Humanos , Imagen por Resonancia Magnética , Meningitis/líquido cefalorraquídeo , Meningitis/complicaciones , Meningitis/diagnóstico por imagen , Prednisolona/uso terapéutico
8.
Hosp Pediatr ; 9(9): 665-672, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31434686

RESUMEN

OBJECTIVES: To explore the accuracy of using a point-of-care (POC) glucometer for cerebrospinal fluid (CSF) glucose screening. METHODS: A cross-sectional study was conducted. A glucose analysis of CSF samples collected from infants <90 days with suspected meningitis was paired between tests by using a POC glucometer (POC-CSF glucose) and a laboratory glucose analysis (laboratory-CSF glucose). Accuracy and limits of agreement were compared, as well as the glucometer performance to detect a laboratory-CSF glucose level <45 and 60 mg/dL. RESULTS: Seventy-three CSF samples were analyzed. Subjects' mean gestational age was 32.2 (SD 4.0) weeks, the mean weight was 1947.7 (SD 814.5) g, and the median age was 8 (interquartile range: 2 to 19.5) days. POC-CSF glucose levels ranged from 26 to 126 mg/dL. The mean (±1.96 SD) difference between POC-CSF and laboratory-CSF glucose levels was -1.6 (interquartile range: -12.6 to 9.4) mg/dL. A POC-CSF glucose level <45 mg/dL has a sensitivity and negative predictive value (NPV) to detect a laboratory-CSF glucose level <45 mg/dL of 82% and 94%, respectively. For a laboratory-CSF glucose level <60 mg/dL, a POC glucose level <60 mg/dL provides a sensitivity and NPV of 96% and 90%, respectively, whereas sensitivity and NPV reach 100% at a POC glucose level <70 mg/dL. CONCLUSIONS: A POC glucometer for CSF glucose can detect a potential abnormal glucose level with an appropriate cutoff level. This may facilitate rapid decisions for empirical antibiotics in suspected meningitis, pending laboratory results in limited-resource settings, but requires robust validation in future studies before implementation.


Asunto(s)
Glucosa/líquido cefalorraquídeo , Pruebas en el Punto de Atención , Estudios Transversales , Países en Desarrollo , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Estudios Prospectivos , Reproducibilidad de los Resultados
9.
Korean J Parasitol ; 57(3): 249-256, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31284347

RESUMEN

Steroids are commonly used in patients with eosinophilic meningitis caused by A. cantonensis infections. The mechanism steroids act on eosinophilic meningitis remains unclear. In this mouse experiments, expressions of 14-3-3 isoform ß and γ proteins significantly increased in the CSF 2-3 weeks after the infection, but not increasedin the dexamethasone-treated group. Expression of 14-3-3 ß, γ, ε, and θ isoforms increased in brain meninges over the 3-week period after infection and decreased due to dexamethasone treatment. In conclusion, administration of dexamethasone in mice with eosinophilic meningitis decreased expressions of 14-3-3 isoform proteins in the CSF and in brain meninges.


Asunto(s)
Proteínas 14-3-3/genética , Angiostrongylus cantonensis/efectos de los fármacos , Dexametasona/administración & dosificación , Eosinofilia/tratamiento farmacológico , Meningitis/genética , Infecciones por Strongylida/genética , Proteínas 14-3-3/líquido cefalorraquídeo , Angiostrongylus cantonensis/fisiología , Animales , Regulación hacia Abajo/efectos de los fármacos , Eosinofilia/líquido cefalorraquídeo , Eosinofilia/genética , Femenino , Humanos , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/parasitología , Ratones , Ratones Endogámicos BALB C , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Infecciones por Strongylida/líquido cefalorraquídeo , Infecciones por Strongylida/tratamiento farmacológico , Infecciones por Strongylida/parasitología
10.
BMC Infect Dis ; 19(1): 560, 2019 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-31242869

RESUMEN

BACKGROUND: Acute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae in children. To determine the etiology of childhood AMES in Shenzhen, a hospital-based study was undertaken. METHODS: A total of 240 cerebrospinal fluid (CSF) samples from 171 children meeting the case definition were included and screened for 12 common causative organisms. The clinical data and conventional testing results were collected and analyzed. Whole genome sequencing was performed on a Neisseria meningitidis isolate. RESULTS: A pathogen was found in 85 (49.7%) cases; Group B Streptococcus (GBS) was detected in 17 cases, Escherichia coli in 15, Streptococcus pneumoniae in 14, enterovirus (EV) in 13, herpes simplex virus (HSV) in 3, N. meningitidis in 1, Haemophilus influenzae in 1, and others in 23. Notably, HSV was found after 43 days of treatment. Twelve GBS and 6 E. coli meningitis were found in neonates aged less than 1 month; 13 pneumococcal meningitis in children aged > 3 months; and 12 EV infections in children aged > 1 year old. The multilocus sequence typing of serogroup B N. meningitidis isolate was ST-3200/CC4821. High resistance rate to tetracycline (75%), penicillin (75%), and trimethoprim/sulfamethoxazole (75%) was found in 4 of S. pneumoniae isolates; clindamycin (100%) and tetracycline (100%) in 9 of GBS; and ampicillin (75%) and trimethoprim/sulfamethoxazole (67%) in 12 of E. coli. CONCLUSIONS: The prevalence of N. meningitidis and JEV was very low and the cases of childhood AMES were mainly caused by other pathogens. GBS and E. coli were the main causative organisms in neonates, while S. pneumoniae and EV were mainly found in older children. HSV could be persistently found in the CSF samples despite of the treatment. A better prevention strategy for GBS, the introduction of pneumococcal vaccine, and incorporation of PCR methods were recommended.


Asunto(s)
Encefalitis/epidemiología , Encefalitis/etiología , Hospitales Pediátricos , Meningitis/epidemiología , Meningitis/etiología , Vigilancia de Guardia , Enfermedad Aguda , Técnicas de Tipificación Bacteriana/métodos , Líquido Cefalorraquídeo/microbiología , Líquido Cefalorraquídeo/virología , Niño , Preescolar , China/epidemiología , Encefalitis/líquido cefalorraquídeo , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Meningitis/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa/métodos , Prevalencia , Índice de Severidad de la Enfermedad , Síndrome , Virología/métodos
11.
J Neuroimmunol ; 334: 576997, 2019 09 15.
Artículo en Inglés | MEDLINE | ID: mdl-31254930

RESUMEN

We describe the case of a 69-year-old man who presented with symptoms of headache and severe vision loss due to G4 immunoglobulin (IgG4) hypertrophic pachymeningitis (HP). The patient was initially responsive to corticotherapy, but vision loss progressed when steroid therapy was first tapered. No improvement was noticed with intravenous rituximab. The patient showed clinical and radiological improvement after intrathecal rituximab, which can be an efficacious alternative treatment option.


Asunto(s)
Antineoplásicos Inmunológicos/administración & dosificación , Inmunoglobulina G/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Meningitis/tratamiento farmacológico , Rituximab/administración & dosificación , Anciano , Humanos , Inyecciones Espinales , Masculino , Meningitis/diagnóstico por imagen , Resultado del Tratamiento
12.
J Vet Intern Med ; 33(4): 1719-1727, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31175683

RESUMEN

BACKGROUND: Steroid-responsive meningitis-arteritis (SRMA) is a common inflammatory neurologic disorder of dogs for which certain breeds are predisposed. OBJECTIVES: To determine whether breed differences exist in clinical features, treatment response, and relapse in a population of North American dogs with SRMA, and to evaluate the effect of disease on dogs' quality of life (QoL). ANIMALS: Sixty-one client-owned dogs with SRMA: 29 dogs identified through an American Kennel Club-Canine Health Foundation survey and 32 dogs from North Carolina (NC) State Veterinary Hospital. METHODS: Retrospective case series. Caregivers completed an online survey to assess QoL. RESULTS: Breeds represented most often included the Golden Retriever (n = 12), Bernese Mountain Dog (10), Wirehaired Pointing Griffon (9), Boxer (9), and Beagle (6). No breed differences were identified with respect to clinical severity, diagnostic findings, or outcome. Twenty-nine dogs (48%) had ≥1 disease relapse. There was a significant effect of cerebrospinal fluid nucleated cell count on the frequency of disease relapse (P = .003), but no relationship was identified between treatment protocol and relapse. Dogs' QoL was associated with the severity of corticosteroid-related adverse effects (P = .03), which were dose-related (r = .24, P = .02) and more prevalent in Wirehaired Pointing Griffons than in other breeds (P = .04). CONCLUSION AND CLINICAL IMPORTANCE: Golden Retrievers and Wirehaired Pointing Griffons should be considered among the breeds recognized to develop SRMA. Treatment with higher corticosteroid dosages is correlated with more severe adverse effects and worse QoL, but it may not improve clinical outcome.


Asunto(s)
Arteritis/veterinaria , Enfermedades de los Perros/patología , Meningitis/veterinaria , Animales , Arteritis/líquido cefalorraquídeo , Arteritis/tratamiento farmacológico , Canadá/epidemiología , Enfermedades de los Perros/líquido cefalorraquídeo , Enfermedades de los Perros/tratamiento farmacológico , Perros , Femenino , Predisposición Genética a la Enfermedad , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/tratamiento farmacológico , Neutrófilos , Calidad de Vida , Recurrencia , Estudios Retrospectivos , Esteroides/administración & dosificación , Esteroides/efectos adversos , Esteroides/uso terapéutico , Encuestas y Cuestionarios , Estados Unidos/epidemiología
13.
Rev. esp. quimioter ; 32(3): 246-253, jun. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-188518

RESUMEN

OBJETIVO: Evaluar el impacto clínico de la PCR-múltiple FilmArray(R) panel Meningitis/Encefalitis en el diagnóstico de infecciones del sistema nervioso central y comparar los resultados obtenidos y el tiempo necesario hasta el diagnóstico con las técnicas microbiológicas convencionales. PACIENTES Y MÉTODOS: Estudio prospectivo observacional en una Unidad de Cuidados Intensivos (UCI) de adultos de un hospital de tercer nivel. Se realizó punción lumbar a todos los pacientes y en el LCR extraído se realizó FilmArray(R) panel de meningitis /encefalitis, estudio citoquímico, Gram y cultivos microbiológicos convencionales. RESULTADOS: 21 pacientes ingresados con sospecha de Meningitis/Encefalitis. Edad: mediana 58,4 años (RIQ 38,1-67,3), APACHE II: mediana 18 (RIQ 12-24). La mediana de estancia en UCI fue de 4 días (RIQ 2-6) y la hospitalaria de 17 días (RIQ 14-28). Mortalidad 14,3%. Se estableció un diagnóstico clínico final de Meningitis/Encefalitis en 16 pacientes, con diagnóstico etiológico en 12 casos (75%). La etiología más frecuente fue Streptococcus pneumoniae (8 casos). FilmArray(R) permitió diagnóstico etiológico en 3 casos con cultivo negativo y el resultado implicó cambios en el tratamiento antibiótico de 7 de los 16 pacientes (43,8%). Para la totalidad de pacientes, FilmArray(R) presentó una sensibilidad y especificidad del 100% y 90% respectivamente. La mediana de tiempo hasta la obtención del resultado de FilmArray(R) fue de 2,9 horas (RIQ 2,1-3,8) y del cultivo incluyendo antibiograma 45,1 horas (RIQ 38,9-58,7). CONCLUSIONES: FilmArray(R) panel Meningitis/Encefalitis realiza un diagnóstico etiológico más precoz que los cultivos convencionales, muestra una mayor sensibilidad y permite realizar un tratamiento antimicrobiano dirigido


OBJECTIVE: To evaluate the clinical impact of Meningitis/Encephalitis FilmArray(R) panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques. PATIENTS AND METHODS: A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray(R) panel ME, cytochemical study, Gram, and conventional microbiological cultures. RESULTS: A total of 21 patients admitted with suspicion of Meningitis/Encephalitis. Median age of patients was 58.4 years (RIQ 38.1-67.3), median APACHE II 18 (RIQ 12-24). Median stay in ICU and median hospital stay was 4 (RIQ 2-6) and 17 days (RIQ 14-28), respectively. The overall mortality was 14.3%. A final clinical diagnosis of meningitis or encephalitis was established in 16 patients, obtaining the etiological diagnosis in 12 of them (75%). The most frequent etiology was Streptococcus pneumoniae (8 cases). FilmArray(R) allowed etiological diagnosis in 3 cases in which the culture had been negative, and the results led to changes in the empirical antimicrobial therapy in 7 of 16 cases (43.8%). FilmArray(R) yielded a global sensitivity and specificity of 100% and 90%, respectively. The median time to obtain results from the latter and conventional culture (including antibiogram) was 2.9 hours (RIQ 2.1-3.8) and 45.1 hours (RIQ 38.9-58.7), respectively. CONCLUSIONS: The Meningitis/Encephalitis FilmArray(R) panel was able to establish the etiologic diagnosis faster than conventional methods. Also, it achieved a better sensitivity and led to prompt targeted antimicrobial therapy


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Encefalitis/diagnóstico , Unidades de Cuidados Intensivos , Meningitis/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Antibacterianos/uso terapéutico , Encefalitis/líquido cefalorraquídeo , Encefalitis/mortalidad , Mortalidad Hospitalaria , Tiempo de Internación , Meningitis/líquido cefalorraquídeo , Meningitis/mortalidad , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos , Sensibilidad y Especificidad , APACHE
14.
PLoS One ; 14(5): e0216498, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31063510

RESUMEN

BACKGROUND: Premature infants are at risk for severe sepsis and meningitis, both infections associated with high mortality and morbidity. Cerebro-spinal fluid (CSF) culture is the gold standard method for meningitis diagnosis, but interpretation of biochemical parameters of CSF is essential at the moment of the analysis in order to start the appropriate treatment. The main objective of this study was to determine whether levels of CSF beta-2-microglobulin (B2M) were elevated in preterm infants with CNS infections or other inflammatory processes, and to establish if there were differences in B2M concentrations amongst various inflammatory settings (sepsis, meningitis, and progressive post-hemorrhagic ventricular dilatation (PHVD)). METHODS: This is a retrospective study of all very preterm and extremely preterm infants (< 32 weeks of gestation) admitted to our NICU between 2012 and 2017. All those who underwent a lumbar puncture during their stay as part of a sepsis work-up or PHVD were considered for inclusion. CSF biochemical parameters and B2M were tested in all of the patients. RESULTS: Fifty-nine patients were included in the study. In patients with CNS infections, the median value of B2M was 8.69 mg/L (3.92-18.5). B2M levels above 3.92 mg/L showed greater sensitivity and specificity than leukocyte levels in discriminating between patients with CNS infections or other inflammatory processes and those without CNS inflammation. CONCLUSIONS: In this population, CSF B2M proved to be an effective biomarker to discriminate between patients with CNS infections and other inflammatory processes and those without CNS inflammation.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Recien Nacido Extremadamente Prematuro/líquido cefalorraquídeo , Enfermedades del Prematuro/diagnóstico , Inflamación/diagnóstico , Hemorragias Intracraneales/diagnóstico , Meningitis/diagnóstico , Sepsis/diagnóstico , Microglobulina beta-2/líquido cefalorraquídeo , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Enfermedades del Prematuro/líquido cefalorraquídeo , Inflamación/líquido cefalorraquídeo , Hemorragias Intracraneales/líquido cefalorraquídeo , Masculino , Meningitis/líquido cefalorraquídeo , Pronóstico , Estudios Retrospectivos , Sepsis/líquido cefalorraquídeo
15.
BMC Vet Res ; 15(1): 148, 2019 May 14.
Artículo en Inglés | MEDLINE | ID: mdl-31088486

RESUMEN

BACKGROUND: Hemorrhage in the spinal canal leads to further damage of the spinal cord influencing outcome in dogs with intervertebral disk (IVD) extrusion. The aim of the study was to evaluate blood degradation products and ferritin in the cerebrospinal fluid (CSF) of dogs with thoracolumbar IVD extrusion, and their association to clinical parameters and MRI findings. RESULTS: In the CSF of dogs with IVD extrusion, both net oxyhemoglobin absorption (NOA) and net bilirubin absorption (NBA) were significantly higher compared to the control groups of dogs with steroid responsive meningitis arteritis (SRMA) and idiopathic epilepsy (IE) (P < 0.001), but NOA compared to the idiopathic epilepsy group contaminated artificially with blood (IEc) was not (P = 0.890). Ferritin concentration was significantly higher in dogs with IVD extrusion compared to dogs with IE (P = 0.034), but not to dogs with SRMA (P = 0.526). There was no association between NOA, NBA or ferritin concentration and severity or duration of clinical signs. In dogs with a higher ferritin concentration the outcome was better (P = 0.018). In dogs with evidence of hemorrhage on MRI, NOA and NBA were significantly higher (P = 0.016, P = 0.009), but not ferritin (P = 0.0628). CONCLUSION AND CLINICAL IMPORTANCE: Quantification of blood degradation products and ferritin in the CSF of dogs to assess subarachnoidal hemorrhage is feasible; however, larger case numbers are needed to evaluate the relevance of NBA and ferritin as prognostic indicators.


Asunto(s)
Bilirrubina/líquido cefalorraquídeo , Enfermedades de los Perros/líquido cefalorraquídeo , Ferritinas/líquido cefalorraquídeo , Degeneración del Disco Intervertebral/veterinaria , Desplazamiento del Disco Intervertebral/veterinaria , Oxihemoglobinas/líquido cefalorraquídeo , Animales , Arteritis/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Perros , Epilepsia/líquido cefalorraquídeo , Epilepsia/veterinaria , Femenino , Degeneración del Disco Intervertebral/líquido cefalorraquídeo , Degeneración del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/líquido cefalorraquídeo , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Imagen por Resonancia Magnética/veterinaria , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/veterinaria , Proyectos Piloto , Estudios Prospectivos
16.
Neurol Sci ; 40(8): 1597-1605, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30982131

RESUMEN

BACKGROUND: Meningitis is an inflammatory process involving meninges. It is difficult to diagnose because of the absence of a diagnostic biomarker. We first report here the possibility of cerebrospinal fluid (CSF) vitamin D-binding protein (VDBP) as a new biomarker for the diagnosis of meningitis. METHODS: This prospective study enrolled a total of 102 subjects (58 patients with non-neurologic disease, 17 patients with meningitis, and 27 patients with other neurologic diseases) from 2017 to 2018. CSF and blood samples were collected in pairs. Total 25(OH)D in CSF and serum and VDBP levels in serum were measured. GC genotyping was also performed to determine polymorphisms of rs4588 and rs7041. CSF total 25(OH)D and VDBP levels were compared with serum total 25(OH)D and VDBP levels according to disease (meningitis vs. non-meningitis). Receiver operating characteristic (ROC) analysis for the diagnosis of meningitis using CSF VDBP level was performed. RESULTS: Mean CSF VDBP and serum VDBP levels of all patients were 1.48 ± 1.32 and 181.28 ± 56.90 µg/mL, respectively. CSF VDBP level in the meningitis disease group (3.20 ± 1.49 µg/mL) was significantly (P < 0.001) higher than that in other disease groups. According to ROC curve analysis, the appropriate cut-off value for CSF VDBP was 1.96 µg/mL, showing sensitivity of 82.4% and specificity of 85.9%. AUC of CSF VDBP was 0.879 (95% CI: 0.789-0.962). CONCLUSIONS: CSF VDBP level showed very good diagnostic performance. It could be used as a potential biomarker for the diagnosis of meningitis.


Asunto(s)
Biomarcadores/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Proteína de Unión a Vitamina D/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Adulto Joven
17.
Rev Esp Quimioter ; 32(3): 246-253, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-30980520

RESUMEN

OBJECTIVE: To evaluate the clinical impact of Meningitis/Encephalitis FilmArray® panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques. METHODS: A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray® panel ME, cytochemical study, Gram, and conventional microbiological cultures. RESULTS: A total of 21 patients admitted with suspicion of Meningitis/Encephalitis. Median age of patients was 58.4 years (RIQ 38.1-67.3), median APACHE II 18 (RIQ 12-24). Median stay in ICU and median hospital stay was 4 (RIQ 2-6) and 17 days (RIQ 14-28), respectively. The overall mortality was 14.3%. A final clinical diagnosis of meningitis or encephalitis was established in 16 patients, obtaining the etiological diagnosis in 12 of them (75%). The most frequent etiology was Streptococcus pneumoniae (8 cases). FilmArray® allowed etiological diagnosis in 3 cases in which the culture had been negative, and the results led to changes in the empirical antimicrobial therapy in 7 of 16 cases (43.8%). FilmArray® yielded a global sensitivity and specificity of 100% and 90%, respectively. The median time to obtain results from the latter and conventional culture (including antibiogram) was 2.9 hours (RIQ 2.1-3.8) and 45.1 hours (RIQ 38.9-58.7), respectively. CONCLUSIONS: The Meningitis/Encephalitis FilmArray® panel was able to establish the etiologic diagnosis faster than conventional methods. Also, it achieved a better sensitivity and led to prompt targeted antimicrobial therapy.


Asunto(s)
Encefalitis/diagnóstico , Unidades de Cuidados Intensivos , Meningitis/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , APACHE , Adulto , Anciano , Antibacterianos/uso terapéutico , Encefalitis/líquido cefalorraquídeo , Encefalitis/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/mortalidad , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad
18.
Sci Rep ; 9(1): 4049, 2019 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-30858412

RESUMEN

Streptococcus pneumoniae, a normal commensal of the upper respiratory tract, is a major public health concern, responsible for substantial global morbidity and mortality due to pneumonia, meningitis and sepsis. Why some pneumococci invade the bloodstream or CSF (so-called invasive pneumococcal disease; IPD) is uncertain. In this study we identify genes associated with IPD. We transform whole genome sequence (WGS) data into a sequence typing scheme, while avoiding the caveat of using an arbitrary genome as a reference by substituting it with a constructed pangenome. We then employ a random forest machine-learning algorithm on the transformed data, and find 43 genes consistently associated with IPD across three geographically distinct WGS data sets of pneumococcal carriage isolates. Of the genes we identified as associated with IPD, we find 23 genes previously shown to be directly relevant to IPD, as well as 18 uncharacterized genes. We suggest that these uncharacterized genes identified by us are also likely to be relevant for IPD.


Asunto(s)
Genoma Bacteriano/genética , Neumonía/genética , Streptococcus pneumoniae/genética , Secuenciación Completa del Genoma , Genes Bacterianos/genética , Humanos , Meningitis/líquido cefalorraquídeo , Meningitis/genética , Meningitis/microbiología , Neumonía/líquido cefalorraquídeo , Neumonía/microbiología , Sepsis/líquido cefalorraquídeo , Sepsis/genética , Sepsis/microbiología , Streptococcus pneumoniae/patogenicidad
19.
J Neuroimmunol ; 330: 38-43, 2019 05 15.
Artículo en Inglés | MEDLINE | ID: mdl-30784775

RESUMEN

Hypertrophic pachymeningitis (HP) is a rare neurologic disease causing inflammatory fibrous thickening of the brain and spinal dura mater. We investigated the cerebrospinal fluid cytokine profile of HP by measuring 28 cytokines/chemokines/growth factors with a multiplexed fluorescent immunoassay in 8 patients with HP (6 idiopathic, 1 IgG4-related, 1 anti-neutrophil cytoplasmic antibody-related), and 11 with other non-inflammatory neurologic diseases (OND). Interleukin (IL)-4, IL-5, IL-9, IL-10, TNF-α, and CXCL8/IL-8 levels were significantly higher in idiopathic HP (IHP) than OND. Cluster analyses disclosed two major clusters: one mainly consisted of IHP and the other of OND, suggesting a unique cytokine profile in IHP.


Asunto(s)
Quimiocinas/líquido cefalorraquídeo , Citocinas/líquido cefalorraquídeo , Péptidos y Proteínas de Señalización Intercelular/líquido cefalorraquídeo , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Anciano , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Quimiocinas/sangre , Citocinas/sangre , Femenino , Humanos , Péptidos y Proteínas de Señalización Intercelular/sangre , Masculino , Meningitis/sangre , Persona de Mediana Edad , Células Th2/metabolismo
20.
J Neuroinflammation ; 16(1): 42, 2019 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-30777092

RESUMEN

BACKGROUND: Varicella-zoster virus (VZV) is a common viral agent causing central nervous system (CNS) infections including encephalitis, meningitis, and Ramsay Hunt syndrome. Neurological complications occur frequently despite antiviral treatment. Matrix metalloproteinases (MMPs) and cytokines are involved in the neuroinflammatory response during CNS infection. Their role in VZV CNS infections and how they differ between different CNS entities caused by VZV are poorly investigated. METHODS: We analyzed the levels of 30 chemokines and 9 MMPs in cerebrospinal fluid (CSF) and serum from 66 patients with VZV CNS infections diagnosed by detection of VZV DNA in CSF and concomitant neurological symptoms and compared with a control group (n = 24). RESULTS: Levels of CCL19, CXCL8, CXCL9, and CXCL10 were significantly increased and surpassing the levels in serum when analyzing all patients with VZV CNS infections whereas CXCL11 was only increased in CSF of patients with VZV meningitis. MMP-2-levels were highly elevated in CSF of all 66 VZV patients. The patients with encephalitis had the most significantly increased levels of MMPs in CSF, and MMP-3, MMP-8, and MMP-12 were exclusively increased in this group, whereas MMP-9 in CSF was increased in the patients with VZV meningitis. CONCLUSIONS: We show that both chemokines and MMPs are elevated in the CSF of patients with VZV CNS infections. Encephalitis and meningitis patients differed with respect to other chemokines (CXCL11) and MMPs (MMP-3, MMP-8, MMP-9, and MMP-12), indicating that different location of the virus gives rise to qualitative differences in the ensuing inflammatory response. In addition, the pronounced increase of MMPs in CSF of the patients with encephalitis suggests an association to the severity of this manifestation, compared to VZV meningitis and Ramsay Hunt syndrome. The role of MMPs in association to chemokines should be further investigated to evaluate their significance in the neuropathogenesis of VZV CNS infections and as a potential target for new treatment alternatives.


Asunto(s)
Quimiocinas/líquido cefalorraquídeo , Encefalitis por Varicela Zóster/líquido cefalorraquídeo , Herpesvirus Humano 3/patogenicidad , Metaloproteinasas de la Matriz/líquido cefalorraquídeo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Herpes Zóster Ótico/líquido cefalorraquídeo , Herpes Zóster Ótico/virología , Herpesvirus Humano 3/genética , Humanos , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/virología , Persona de Mediana Edad , Suecia , Carga Viral , Adulto Joven
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