Polymerase chain reaction for the laboratory diagnosis of aseptic meningitis and encephalitis.

A protocol for testing cerebrospinal fluid specimens using a range of PCR assays for the diagnosis of central nervous system infection was developed and used to test prospectively 383 specimens. PCR assays were used for the detection of adenovirus, Borrelia burgdorferi, enteroviruses, Epstein Barr virus, cytomegalovirus, herpes simplex virus, human herpes virus type 6, JC virus, Leptospira interrogans, Listeria monocytogenes, lymphocytic choriomeningitis virus, measles virus, mumps virus, Mycobacterium sp. , Mycoplasma pneumoniae, Toxoplasma gondii and varicella zoster virus. Of the 383 specimens tested in this study, 46 (12.0%) were found to be positive. The microorganisms detected were CMV, enterovirus, Epstein Barr virus, herpes simplex virus, human herpes virus type 6, JC virus, L. monocytogenes, Mycobacterium genus, Toxoplasma gondii and varicella zoster virus. The introduction of the PCR protocol described has improved the diagnosis of a range of central nervous system infections in our laboratory. We believe however that further evaluation of these assays in immunocompromised patients is necessary to better determine the predictive value of positive PCR results in these patient groups.

Mortalidade perinatal e neonatal no Hospital de Clínicas de Porto Alegre / Perinatal and neonatal mortality at the Hospital de Clinicas de Porto Alegre, Brazil

Objetivo. Análise epidemiológica da mortalidade neonatal e perinatal de 20.280 crianças nascidas vivas com 500g ou mais e 374 natimortos ocorridas no Hospital de Clínicas de Porto Alegre, no período de 1984 a 1990. Proposta. Comparar dois períodos: A (1984-1987) com B (1988-1990), estabelecendo as mudanças ocorridas. Métodos. É um estudo retrospectivo de revisao dos registros de nascimentos do centro obstétrico, internaçoes e óbitos da unidade neonatal e mortes fetais e dos laudos de necrópsia. Resultados. Faleceram 258 RN, com um coeficiente de mortalidade noenatal de 12,7 por mil. A taxa de natimortalidade foi de 18,4 por mil. O coeficiente de mortalidade perinatal foi de 28,4 por mil. A incidência de baixo peso ao nascer (<2.500g), de 11,2 por cento, e a de muito baixo peso ao nascer (<1.500g) foi de 1,8 por cento. Este último grupo aumentou sua incidência de 1,5 por cento (A) para 2,2 por cento (B). As causas mais freqüentes de morte neonatal foram: a) infecçao intra-uterina (22,4 por cento); b) doença de membrana hialina (20,1 por cento); c) malformaçoes múltiplas (18,2 por cento); d) asfixia perinatal (15,5 por cento); e) infecçoes pós-natais específicas (9,7 por cento). As causas de morte fetal foram: a) asfixia (38,7 por cento); b) infecçoes intra-uterinas (9 por cento); c) toxemia (8,2 por cento); d) malformaçoes múltiplas (7,4 por cento). No período B, foi significativo o aumento de óbitos por infecçoes pós-natais, OR 7 (1,9-30,6) e por malformaçoes congênitas, OR 1,6 (0,8-3,2). Nao houve reduçao significativa na taxa de mortalidade em menores de 1.500g OR 90 (61-118) em A para 54 (37-68) em B. Conclusao. Nao houve reduçao nas taxas de mortalidade neonatal, apesar dos avanços tecnológicos e na capacitaçao técnica.

[Perinatal and neonatal mortality at the Clinicas de Porto Alegre Hospital, Brazil]. / Mortalidade perinatal e neonatal no Hospital de Clínicas de Porto Alegre.

OBJECTIVE: Epidemiological analysis of neonatal and perinatal mortality of 20,280 newborns alive with 500g or more and 374 stillbirths occurred at the Hospital de Clínicas de Porto Alegre from 1984 to 1990. PURPOSE: To compare two periods: A (1984-1987) with B (1988-1990), establishing a relationship between the changes occurred in the causes and the rate of mortality. METHODS: The retrospective study was done with the records of promptuaries of obstetrical and neonatal centers, and review of flow-sheets of the deaths and autopsies. RESULTS: Between 1984 to 1990, 20,280 newborns alive with 500g or more, 374 stillbirths at perinatal unit of Hospital de Clínicas de Porto Alegre were born. 258 deaths occurred, the neonatal mortality rate was 12.7 per thousand. The stillbirth rate was 18.4 per thousand. The perinatal mortality rate was 28.4 per thousand. The incidence of low birth weight (< 2,500g) was 11.2% and very low birth weight (< 1,500 g) was 1.8%, the former group had an increase incidence between 1984-1988 (A) from 1.5% to 2.2% (B). The causes of deaths were distributed as follow: a) intrauterine infections (22.4%); b) hyaline membrane disease (20.1%); c) congenital malformation (18.2%); d) asphyxia (15.5%); e) postnatal infections (9.7%). The causes of stillbirth were: a) perinatal asphyxia (38.7%); b) intrauterine infections (9%); toxemia (8.2%); d) malformation (7.4%). The period B showed changes with an increase of postnatal infections odds ration (OR) 7 (1.9-30.6) and congenital malformations OR 1.6 (0.8-3.2). It did not occurred a decrease in mortality rate for prematures below 1,500g OR 90 (61-118) in A to 54 (37-68) in B. CONCLUSIONS: The advantages in technology and human capacity were not sufficient to reduce significantly the rate of neonatal mortality.