ABSTRACT
The clinical management of meningitis caused by Escherichia coli is greatly complicated when the organism becomes resistant to broad-spectrum antibiotics. We sought to characterize the antimicrobial susceptibilities, sequence types (ST), and presence of known drug resistance genes of E. coli isolates that caused meningitis between 1996 and 2011 in Salvador, Brazil. We then compared these findings to those for E. coli isolates from community-acquired urinary tract infections (UTI) that occurred during the same time period and in the same city. We found that 19% of E. coli isolates from cases of meningitis and less than 1% of isolates from UTI were resistant to third-generation cephalosporins. The sequence types of E. coli isolates from cases of meningitis included ST131, ST69, ST405, and ST62, which were also found among isolates from UTI. Additionally, among the E. coli isolates that were resistant to third-generation cephalosporins, we found genes that encode the extended-spectrum beta-lactamases CTX-M-2, CTX-M-14, and CTX-M-15. These observations demonstrate that compared to E. coli strains isolated from cases of community-acquired UTI, those isolated from cases of meningitis are more resistant to third-generation cephalosporins, even though the same sequence types are shared between the two forms of extraintestinal infections.
Subject(s)
Community-Acquired Infections/microbiology , Escherichia coli Infections/microbiology , Escherichia coli/isolation & purification , Meningitis/microbiology , Anti-Bacterial Agents/pharmacology , Brazil , Cephalosporins/pharmacology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/metabolism , Escherichia coli/drug effects , Escherichia coli/metabolism , Escherichia coli Infections/drug therapy , Escherichia coli Infections/metabolism , Escherichia coli Proteins/metabolism , Humans , Meningitis/drug therapy , Meningitis/metabolism , Microbial Sensitivity Tests/methods , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , beta-Lactamases/metabolismABSTRACT
Streptococcus agalactiae (GBS) is a major cause of severe morbidity and mortality in neonates and young infants, causing sepsis, pneumonia and meningitis. The survivors from this meningitis can suffer serious long-term neurological consequences, such as, seizures, hearing loss, learning and memory impairments. Neurotrophins, such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) control the neuronal cell death during the brain development and play an important role in neuronal differentiation, survival and growth of neurons. Neonate Wistar rats, received either 10µL of sterile saline as a placebo or an equivalent volume of GBS suspension at a concentration of 1×10(6)cfu/mL. Sixty days after induction of meningitis, the animals underwent behavioral tests, after were killed and the hippocampus and cortex were retired for analyze of the BDNF and NGF levels. In the open-field demonstrated no difference in motor, exploratory activity and habituation memory between the groups. The step-down inhibitory avoidance, when we evaluated the long-term memory at 24h after training session, we found that the meningitis group had a decrease in aversive memory when compared with the long-term memory test of the sham group. BDNF levels decreased in hippocampus and cortex; however the NGF levels decreased only in hippocampus. These findings suggest that the meningitis model could be a good research tool for the study of the biological mechanisms involved in the behavioral alterations secondary to GBS meningitis.
Subject(s)
Brain-Derived Neurotrophic Factor/metabolism , Memory Disorders/etiology , Meningitis/complications , Meningitis/metabolism , Meningitis/mortality , Nerve Growth Factor/metabolism , Animals , Animals, Newborn , Avoidance Learning , Brain/metabolism , Brain/microbiology , Brain/pathology , Disease Models, Animal , Exploratory Behavior , Gene Expression Regulation , Inhibition, Psychological , Male , Memory Disorders/microbiology , Meningitis/etiology , Rats , Rats, Wistar , Reaction Time , Statistics, Nonparametric , Streptococcal Infections/complicationsABSTRACT
Neonatal meningitis is an illness characterized by inflammation of the meninges and occurring within the birth and the first 28 days of life. Invasive infection by Streptococcus pneumoniae, meningitis and sepsis, in neonate is associated with prolonged rupture of membranes; maternal colonization/illness, prematurity, high mortality and 50% of cases have some form of disability. For this purpose, we measured brain levels of TNF-α, IL-1ß, IL-6, IL-10, CINC-1, oxidative damage, enzymatic defense activity and the blood-brain barrier (BBB) integrity in neonatal Wistar rats submitted to pneumococcal meningitis. The cytokines increased prior to the BBB breakdown and this breakdown occurred in the hippocampus at 18 h and in the cortex at 12h after pneumococcal meningitis induction. The time-dependent association between the complex interactions among cytokines, chemokine may be responsible for the BBB breakdown and neonatal pneumococcal severity.
Subject(s)
Blood-Brain Barrier/physiopathology , Gene Expression Regulation/physiology , Inflammation Mediators/metabolism , Meningitis , Pneumococcal Infections/complications , Animals , Animals, Newborn , Cerebral Cortex/metabolism , Cerebral Cortex/microbiology , Cerebral Cortex/pathology , Disease Models, Animal , Hippocampus/metabolism , Hippocampus/microbiology , Hippocampus/pathology , Meningitis/etiology , Meningitis/metabolism , Meningitis/pathology , Rats , Time FactorsABSTRACT
Eosinophilic meningitis is an emerging disease in western hemisphere produced by Angiostrongylus cantonensis. It was first reported in Cuba in 1981, later was spreading for the Caribbean basin and recently in Ecuador. Ecuadorians have typical intrathecal major immunoglobulins synthesis patterns that are different to Cuban ones. There is a molecular differentiation and phylogenetic relationships of three A. cantonensis geographical isolates. Differentiation in the neuroimmunological patterns found in patients from different countries may be explained by taking into account different strains of the helmint. Here, we discuss that the different between intrathecal synthesis patterns of major immunoglobulins found in patients from different geographical regions not directed linked is due to different circulating strains that produce typical patterns.
Subject(s)
Angiostrongylus cantonensis/isolation & purification , Immunoglobulins/biosynthesis , Meningitis/metabolism , Angiostrongylus cantonensis/classification , Animals , Humans , Meningitis/parasitology , Models, Theoretical , PhylogenyABSTRACT
BACKGROUND: Most of bayesian pharmacokinetic studies and the influence of clinical variables have been carried out in adults. PURPOSE: The aim was to estimate population-based pharmacokinetic of valproic acid (VPA) and to determine the effect of treatment and additional disease on its performance in children with epilepsy. MATERIAL AND METHODS: For the study steady-state serum concentrations of VPA were determined from 108 epileptic patients (44 females and 64 males) who were receiving the anticonvulsant as main drug of treatment with age range since 1 to 16 years (median 4y, 6m) and weight since 5.2 to 50 kg (median 17.5 kg). All patients had their renal, hepatic and nutritional functions normal. One compartment model using interactive two-stage Bayesian approach was employed in the analysis. RESULTS; Population estimates of CL/F and V/F for VPA were 0.022 +/- 0.013 L/h and 0.217 +/- 0.134 L/kg, respectively. These estimates were significantly affected by weight, age, carbamazepine (CBZ) and gastroesophageal reflux (GER). The final regression models were: CL/F (L/h) = 0.0696 + 0.0031 (Age) + 0.0075 (Weight); and V/F (L) = 0.674 + 0.0308 (Age) + 0.0756 (Weight). Prediction of VPA serum concentration in other validation group revealed an important improvement in the predictive performance of VPA concentrations in comparison with the basic model that did not include any co-variables. CONCLUSIONS: Based on a population model of children with epilepsy, the pharmacokinetic of VPA could be altered by weight, age and the administration of CBZ and additional GER to epilepsy.
Subject(s)
Anticonvulsants/pharmacokinetics , Epilepsy/drug therapy , Valproic Acid/pharmacokinetics , Adolescent , Age Factors , Anticonvulsants/administration & dosage , Anticonvulsants/blood , Anticonvulsants/therapeutic use , Bayes Theorem , Body Weight , Brain Injuries/complications , Brain Injuries/metabolism , Carbamazepine/administration & dosage , Carbamazepine/pharmacokinetics , Carbamazepine/therapeutic use , Child , Child, Preschool , Drug Interactions , Drug Therapy, Combination , Epilepsy/complications , Epilepsy/metabolism , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/metabolism , Humans , Infant , Male , Meningitis/complications , Meningitis/metabolism , Models, Biological , Respiratory Tract Infections/complications , Respiratory Tract Infections/metabolism , Valproic Acid/administration & dosage , Valproic Acid/blood , Valproic Acid/therapeutic useABSTRACT
A meningococcal group B (15:P1.3) outer membrane protein vaccine was tested for efficacy in a randomized, double-blind controlled study in Iquique, Chile. A total of 40 811 volunteers, ages 1-21 years, enrolled in the study. Volunteers received two doses of vaccine six weeks apart by jet injector. Both the experimental vaccine and the control vaccine (Menomune, A, C, Y and W135 meningococcal polysaccharide vaccine) were well tolerated with minor side-effects. Active surveillance for suspected cases of meningococcal disease was conducted for 20 months in Iquique. Eighteen cases of group B meningococcal disease were confirmed during the 20 months. Efficacy was estimated to be 51% (p = 0.11) for all ages combined. In children aged 1-4 no protection was evident, but in volunteers aged 5-21 vaccine efficacy was 70% (p = 0.045). The IgG antibody response by ELISA was characterized by a large booster effect after the second dose, followed by a substantial drop in antibody levels by 6 months. The youngest children had the highest responses. The bactericidal antibody response, on the other hand, was characterized by the lack of a significant booster response, higher responses in the older children, and an increase in the geometric mean titer in the later months of the study in the older children.
Subject(s)
Bacterial Outer Membrane Proteins/immunology , Bacterial Vaccines/immunology , Meningitis/immunology , Neisseria meningitidis/immunology , Porins , Adolescent , Adult , Antibodies, Bacterial/biosynthesis , Bacterial Vaccines/administration & dosage , Bacterial Vaccines/adverse effects , Blotting, Western , Child , Child, Preschool , Chile , Complement System Proteins/metabolism , Double-Blind Method , Enzyme-Linked Immunosorbent Assay , Female , Humans , Infant , Male , Meningitis/metabolism , Meningitis/prevention & control , Pharynx/microbiology , Prospective StudiesABSTRACT
Se estudian 60 niños con meningitis purulenta con el objetivo de evaluar la incidência de Síndrome de Secreción Inapropiada de Hormona Antideurética (SSIHAD). El diagnóstico de esta complicación se apoyó en el hallazgo de hiponatremia, hipoosmolaridad sérica y aumento de la densidad urinaria en ausencia de deshidratación o enfermedad suprarrenal. 17 niños llevaron los criterios diagnósticos del síndrome, 28%. Se analizam los mecanismos fisiopatológicos envueltos en la génesis del SSIHAD
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Inappropriate ADH Syndrome/complications , Meningitis/complications , Inappropriate ADH Syndrome/metabolism , Meningitis/metabolism , Nitrogen/urine , Osmolar Concentration , Sodium/bloodSubject(s)
Cefotaxime/analogs & derivatives , Cerebral Ventricles , Encephalitis/metabolism , Cefotaxime/metabolism , Cefotaxime/therapeutic use , Ceftriaxone , Child , Child, Preschool , Encephalitis/drug therapy , Humans , Infant , Infant, Newborn , Kinetics , Meningitis/drug therapy , Meningitis/metabolismSubject(s)
Meningitis/microbiology , Adolescent , Adult , Child , Child, Preschool , Disease Susceptibility , Female , Humans , Infant , Infant, Newborn , Jamaica , Male , Meningitis/diagnosis , Meningitis/drug therapy , Meningitis/epidemiology , Meningitis/metabolism , Middle Aged , Prognosis , Recurrence , Retrospective StudiesABSTRACT
A retrospective study is reported on 215 cases of infectious meningitis seen during a 16-year period (1965-1980) at the University Hospital of the West Indies, Kingston, Jamaica. A detailed analysis was made of the aetiology, epidemiology, signs and symptoms, associated conditions, laboratory investigations, treatment regimes as well as outcome. The most common causative organism of bacterial meningitis was Streptococcus pneumoniae (29.3 percent), being seen in all age groups except in neonates. Haemophilus influenzae (23 percent) was the most frequent cause in pre-school children. Unusual pathogens constituted a major group of bacterial meningitis, accounting for 34 (21.3 percent). Of 11 neonates recorded, 7 (63.6 percent) belonged to this latter group. There were 48 (22.3 percent) cases of aseptic meningitis, 5 tuberculous and 2 cryptococcal. The overall mortality was 14.4 percent. The fatality rate in pneumococcal meningitis was 25.5 percent whereas in that caused by Haemophilus it was 2.7 percent. No deaths were recorded in the aseptic group. The gram stain was useful in 65 percent of cases of bacterial meningitis. One third of aseptic cases had 50 percent or more of neutrophils in the CSF. The highest CSF white cell count in aseptic and bacterial meningitis was 2,176 and 36,000 cells/mm3, respectively. The highest CSF protein level in bacterial and aseptic meningitis was 774 mg/100 ml and 150 mg/ml, respectively. Because of the high incidence of unusual pathogens, there is a need for a modified approach to initial antibiotic treatment bearing in mind the multiple antibiotic-resistant strains that are frequently encountered (AU)
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Meningitis/microbiology , Disease Susceptibility , Meningitis/diagnosis , Meningitis/drug therapy , Meningitis/epidemiology , Meningitis/metabolism , Prognosis , Recurrence , Retrospective Studies , JamaicaABSTRACT
We studied the serum pharmacokinetics and cerebrospinal fluid concentrations of cefoperazone in 15 children with acute meningitis. Mean cefoperazone concentrations of 117 micrograms/ml in the serum and 3.8 micrograms/ml in the cerebrospinal fluid were noted 2 hours after a single 100 mg/kg dose. Following multiple 50 or 100 mg/kg doses, the mean peak serum cefoperazone concentrations were 232 and 498 micrograms/ml, respectively, with an overall mean elimination phase half-life of 2.12 hours. The data best fit a linear, two-compartment model. Cerebrospinal fluid concentrations 1.5 to 2.5 hours after the end of cefoperazone infusions ranged from 1.4 to 19.2 micrograms/ml for all doses and states of illness. This represented 1.2% to 6.4% of simultaneous serum values. The cerebrospinal fluid inhibitory titer was greater than or equal to 1:16 in 17 of 18 specimens tested against a strain of Haemophilus influenzae type b resistant to both chloramphenicol and ampicillin. In the doses given, cefoperazone produces adequate cerebrospinal fluid concentrations and bioactivity to treat the common bacterial forms of acute meningitis in infants and children.