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1.
Med. clín (Ed. impr.) ; 153(5): 205-212, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183997

RESUMO

El incremento de los viajes internacionales, la creciente presencia de vectores transmisores de arbovirus en nuestro país, las alertas de fiebres hemorrágicas, como el actual brote de ébola en la R. D. del Congo y los casos autóctonos de fiebre hemorrágica de Crimea-Congo en nuestro país, ponen de nuevo en primer plano las enfermedades tropicales. El aislamiento de los casos sospechosos de enfermedades de alta transmisibilidad y letalidad ha de ser una prioridad (fiebres hemorrágicas, MERS-CoV). Al valorar al paciente, una cuidadosa historia clínica basada en los aspectos epidemiológicos de la zona de procedencia, las actividades realizadas, el tiempo de estancia en el mismo y el inicio de los síntomas nos ayudarán finalmente, si no al diagnóstico definitivo, sí al menos a descartar las enfermedades que signifiquen una amenaza para él. Por su frecuencia y gravedad la malaria debe ser descartada, sin olvidar las otras causas habituales de fiebre con las que el médico de urgencias debe estar familiarizado también


The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors


Assuntos
Humanos , Controle Sanitário de Viajantes , Doença Relacionada a Viagens , Isolamento de Pacientes/tendências , Saúde do Viajante , Doenças Transmissíveis Importadas/epidemiologia , Febres Hemorrágicas Virais/epidemiologia , Infecções por Arbovirus/epidemiologia , Arbovirus/isolamento & purificação , Meningite/epidemiologia , Febre Tifoide/epidemiologia , Rickettsia/isolamento & purificação , Coronavirus/isolamento & purificação , Esquistossomose/epidemiologia
2.
Zhonghua Er Ke Za Zhi ; 57(8): 592-596, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352743

RESUMO

Objective: To investigate the clinical characteristics of invasive Haemophilus influenzae (HI) infection in children. Methods: The clinical manifestations, laboratory examinations and treatment outcomes of 84 children with HI infection confirmed by bacterial culture in 7 tertiary children's hospitals from 2014 to 2018 were analyzed retrospectively. Results: Among the 84 cases, 50 were males. The age was 1.54 years (ranged from 5 days to 13 years).Twenty cases (24%) had underlying diseases and 48 cases (57%) had not received antibiotics before collecting specimens. Eighty-two cases (98%) had fever and 75 cases (89%) had clear infection foci, among which 31 cases (37%) had meningitis and 27 cases (32%) had pneumonia. Blood culture was positive in 62 cases (74%), cerebrospinal fluid culture was positive in 10 cases (12%), blood culture and cerebrospinal fluid culture were both positive in 11 cases (13%). Antibiotics susceptibility test showed that 27% (22/82) of all HI strains produced ß-lactamases and 48% (37/77) strains were resistant to ampicillin. The drug resistance rates to cefuroxime, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and azithromycin were 25% (20/80) , 20% (9/45) , 71% (44/62) and 19%(11/58), respectively. All strains were sensitive to meropenem, levofloxacin and ceftriaxone. After sensitive antibiotic therapy, 83% (70/84) of all patients were cured and improved, the mortality rate and loss of follow-up rate were 13% (11/84) and 4% (3/84) respectively. Conclusions: Meningitis and pneumonia are common presentation of invasive HI infections in children. Mortality in HI meningitis children is high and the third generation of cephalosporins, such as ceftriaxone can be used as the first choice for the treatment of invasive HI infection.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae/isolamento & purificação , Adolescente , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae/efeitos dos fármacos , Humanos , Lactente , Masculino , Meningite/epidemiologia , Testes de Sensibilidade Microbiana , Pneumonia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamases/metabolismo
3.
Ulus Travma Acil Cerrahi Derg ; 25(4): 383-388, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297771

RESUMO

BACKGROUND: The impact of decompressive craniectomy (DC) on the overall outcome of pediatric acute subdural hematoma patients has not been fully determined to date. In this paper, we aimed to investigate the role of decompressive craniectomy performed to treat traumatic subdural hematoma in patients from the pediatric age group. METHODS: We described our experience with DC in pediatric acute subdural hematoma patients and analyzed the outcomes. RESULTS: Eleven (7 unilateral and 4 bilateral) DCs were performed. The patients' ages ranged from 8 months to 15 years. The mean GCS score at admission was 7.8. All patients underwent DC with duraplasty within 2 hours of injury. All the patients were admitted to the intensive care unit for 10 days postoperatively. The mean hospital stay was 22 days and the mean follow-up period was 3.7 years. CONCLUSION: Early DC for pediatric subdural hematoma patients, independent of their initial GCS, was recommended. Larger studies are needed to define the indications, surgical techniques, and timing of DC in the pediatric population.


Assuntos
Craniectomia Descompressiva , Hematoma Subdural/cirurgia , Acidentes por Quedas , Adolescente , Criança , Pré-Escolar , Craniectomia Descompressiva/métodos , Craniectomia Descompressiva/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Hematoma Subdural/epidemiologia , Hematoma Subdural/etiologia , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Meningite/epidemiologia , Meningite/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
4.
BMC Infect Dis ; 19(1): 560, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242869

RESUMO

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.


Assuntos
Encefalite/epidemiologia , Encefalite/etiologia , Hospitais Pediátricos , Meningite/epidemiologia , Meningite/etiologia , Vigilância de Evento Sentinela , Doença Aguda , Técnicas de Tipagem Bacteriana/métodos , Líquido Cefalorraquidiano/microbiologia , Líquido Cefalorraquidiano/virologia , Criança , Pré-Escolar , China/epidemiologia , Encefalite/líquido cefalorraquidiano , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/líquido cefalorraquidiano , Reação em Cadeia da Polimerase/métodos , Prevalência , Índice de Gravidade de Doença , Síndrome , Virologia/métodos
5.
J Chemother ; 31(5): 290-293, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31215358

RESUMO

Streptococcus pneumoniae is the main pathogen in invasive, life-threatening diseases such as bacteremia, meningitis, and pneumonia. We describe three cases of breakthrough pneumococcal severe life-threatening infections, including two meningitis and one bloodstream infection in patients treated with cefixime for otitis, sinusitis and pneumonia, respectively. Cefixime does not seem to be fully effective in treating invasive pneumococcal diseases. Because penicillin non-susceptibility might be linked to cefixime failure, the prompt knowledge of susceptibility to penicillin in S. pneumoniae might be very useful. Furthermore, MIC of cefixime should be measured because values >0.5 mg/L might be related to failure.


Assuntos
Bacteriemia/epidemiologia , Cefixima/efeitos adversos , Meningite/epidemiologia , Infecções Pneumocócicas/tratamento farmacológico , Pneumonia/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Adulto , Antibacterianos/efeitos adversos , Bacteriemia/induzido quimicamente , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Meningite/induzido quimicamente , Infecções Pneumocócicas/microbiologia , Pneumonia/induzido quimicamente , Prognóstico , Adulto Jovem
6.
Parasitol Int ; 72: 101944, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31220635

RESUMO

Climate change and other weather factors are associated with several infectious diseases, but are rarely reported as being associated with nematode infection. Eosinophilic meningitis (EOM) is an emerging disease worldwide caused by the nematode, Angiostrongylus cantonensis. It is transmitted through various agents such as snails and slugs. Temperature and rainfall are associated with snail population. There have been no previous studies on the relationship between weather and EOM. This was an ecological study. Numbers of EOM patients and weather data in Thailand's Loei province from 2006 to 2017 were obtained using a national database. A Spearman correlation was used to explore the relationship between EOM and weather variables. We developed a Poisson time series model combined with a distributed lag model (DLM) for estimating the effects of weather on EOM. We also created an autoregressive integrated moving average with exogeneous variable (ARIMAX) model for predicting future EOM cases over the following 12 months. There were 1126 EOM patients in the study. Among several weather factors, wind was significantly negatively correlated with the number of EOM patients (rs: -0.204, 95% CI: -0.361 to -0.058; p value: 0.014). The ARIMAX(3, 0, 0) model with wind speed as a variable was appropriate for predicting the number of EOM patients. The predicted and actual numbers of EOM patients in 2018 were highly concordant. In conclusion, wind speed is significantly negatively correlated with the number of EOM patients.


Assuntos
Ecossistema , Eosinofilia/parasitologia , Meningite/parasitologia , Infecções por Strongylida/epidemiologia , Tempo (Meteorologia) , Vento , Angiostrongylus cantonensis/isolamento & purificação , Animais , Mudança Climática , Humanos , Meningite/epidemiologia , Distribuição de Poisson , Caramujos/parasitologia , Infecções por Strongylida/complicações , Temperatura Ambiente , Tailândia/epidemiologia
7.
Orv Hetil ; 160(21): 822-828, 2019 May.
Artigo em Húngaro | MEDLINE | ID: mdl-31104499

RESUMO

Introduction: Congenital sensorineural hearing loss is one of the most common sensory defects affecting 1-3 children per 1000 newborns. There are a lot of causes which result in congenital hearing loss, the most common is the genetic origin, but infection, cochlear malformation or other acquired causes can be reasons as well. Aim: The aim of this study was to establish the etiological factors of congenital profound sensorineural hearing loss in children who underwent cochlear implantation. Results: Our results show that the origin of the hearing loss was discovered in 62.9% of our patients. The most common etiological factor was the c.35delG mutation of the gap junction protein ß-2 gene, the allele frequency was 38.7% in our cohort. Infection constituted to 10.1%, and meningitis and cytomegalovirus infection were the second most common cause. 79.9% of our patients received sufficient hearing rehabilitation before the end of the speech development's period (6 years old), but 11.2% of our cases were still diagnosed late. Conclusions: Based on our data we can state that genetic evaluation is crucial in the diagnostic process of congenital profound sensorineural hearing loss. Sufficient hearing rehabilitation affects the whole life of the child, and by late cochlear implantation the speech development falls behind. We can decrease the ratio of the late implantation with the new protocol of newborn hearing screening, and with sufficient information provided to the colleagues, so the children may be referred to the proper center for rehabilitation without delay. Orv Hetil. 2019; 160(21): 822-828.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Conexinas/genética , Infecções por Citomegalovirus/complicações , Perda Auditiva Neurossensorial/etiologia , Meningite/complicações , Criança , Estudos de Coortes , Infecções por Citomegalovirus/epidemiologia , Audição , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/epidemiologia , Humanos , Recém-Nascido , Meningite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Resultado do Tratamento
8.
S Afr Med J ; 109(5): 333-339, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31131801

RESUMO

BACKGROUND: Public health facilities are used by the majority of South Africans, and healthcare utilisation surveys have been a useful tool to estimate the burden of disease in a given area. OBJECTIVES: To describe care-seeking behaviour in a periurban site with a high prevalence of HIV infection, as well as barriers to seeking appropriate healthcare. METHODS: We conducted a cross-sectional household survey in 22 wards of the Msunduzi municipality in KwaZulu-Natal Province, South Africa, from October to December 2013 using a simple random sample of households selected from a 2011 census enumeration. A primary caregiver/adult decision-maker was interviewed regarding demographic data as well as health status and recent self-reported episodes of selected illnesses and healthcare utilisation. RESULTS: Of the 2 238 eligible premises visited, 1 936 households (87%) with a total of 9 733 members were enrolled in the study. Of these, 635 (7%) reported one or more episodes of infectious illness during the study period. Public health clinics were most frequently consulted for all illnesses (361/635, 57%). Private healthcare (general practitioner, private clinic, private hospital) was sought by 90/635 of individuals (14%), only 13/635 (2%) reported seeking care from traditional healers, religious leaders or volunteers, and 71/635 (11%) did not seek any medical care for acute illnesses. Individuals in the lowest income group were more likely to seek care at public health facilities than those in the highest income group (70% v. 32%). CONCLUSIONS: Public health facility-based surveillance may be representative of disease patterns in this community, although surveillance at household level shows that high-income individuals may be excluded because they were more likely to use private healthcare, and the proportion of individuals who died at home would have been missed by facility-based surveillance. Data obtained in such surveys may be useful for public health planning.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Meningite/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , África do Sul/epidemiologia , Síndrome , Adulto Jovem
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(4): 417-421, 2019 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-31006201

RESUMO

Objective: To understand the trends on the epidemics of acute meningitis and encephalitis (AME) among children under 18 years-old in Shijiazhuang city, 2007-2017. Methods: Surveillance programs on acute meningitis and encephalitis (AMES) had been conducted in population less than 18 years-old, since 2007. Hospitals at county level or above in Shijiazhuang had been included to carry out the epidemiologic surveillance, including 6 on pathogens, regarding AMES. Qualitative description was performed to describe the epidemiologic patterns and pathogenic spectrums. Annual percent change (APC) was used to demonstrate the secular trends of AME. Results: In 2007-2017, 11 222 locally developed AME cases that younger than 18 years-old, were reported in Shijiazhuang, with the annual average incidence rate as 108.62/100 000 (1 021/939 974) and APC as 4.81%(95%CI: 3.90%-5.93%)(t=23.01, P<0.001). Age-specific incidence appeared the highest among 4-5 years-old (242.96 cases per 100 000 children per year). Significant differences were found among children of other aged years except aged 0- years (aged 1- years t=20.21, P=0.004; aged 2- years t=19.41, P=0.006; aged 3- years t=23.50, P<0.001; aged 4- years t=31.76, P<0.001; aged 5- years t=18.53, P=0.008; aged 10-17 years t=12.82, P=0.023). The ratio of male to female was 1.46 ∶ 1 (6 652/4 570). The ratio of urban to rural cases was 0.28 ∶ 1 (2 456/8 766). A total of 57.73% (6 478/11 222) of the cases were seen between June and September. The overall positive rate of pathogens was 20.07% (658/3 123) among these patients. The top five pathogens appeared as Enterovirus (44.68%, 264/658), Cryptococcus neoformans (9.12%, 60/658), Japanese encephalitis virus (8.66%, 57/658), Streptococcus pneumoniae (6.99%, 47/658) and Varicella-zoster virus (6.69%, 44/658). Conclusions: AME seriously harms the health of population under 18 years-old in Shijiazhuang city, with aged 3- years, aged 4- years in particular. Continued improvement on surveillance and expanded immunization are important to AME prevention and control.


Assuntos
Encefalite/epidemiologia , Epidemias , Meningite/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Cidades , Encefalite/etnologia , Encefalite/virologia , Vírus da Encefalite Japonesa (Espécie)/isolamento & purificação , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Meningite/etnologia , Meningite/virologia , População Rural , População Urbana
10.
J Vet Diagn Invest ; 31(3): 453-457, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30852958

RESUMO

Mycoplasmosis is a well-known cause of morbidity and mortality in small ruminants. Previously recognized outbreaks have involved arthritis, and pneumonia or pleuropneumonia. Modern bacteriology procedures rely less on isolation techniques that require special media for mollicutes given that these species are notoriously difficult to isolate, and rely more on PCR tests. We report an outbreak of arthritis, pleuropneumonia, and mild meningitis affecting dairy goat kids, spanning a period of 3 y, which had unusual epidemiologic characteristics related to husbandry practices. Lesions were characterized by polyarthritis of the appendicular joints, with copious joint fluid and extension of arthritic exudate beyond the joint itself. The cause remained unknown until serendipitous isolation of a mycoplasma on blood agar. Mycoplasmosis was not detected from synovial samples by a general mycoplasma PCR, despite multiple attempts. Isolated colonies were also negative by this general PCR assay. The isolate was identified as Mycoplasma mycoides subspecies capri, using universal 16S primers and amplicon sequencing. Testing of additional isolates from other diseased goats in the herd confirmed that this was the cause of illness. A failure to recognize the distinct nature of organisms of the M. mycoides group of mycoplasmas meant that a PCR test that cannot detect this group of organisms was utilized at first, and the etiology of the illness was overlooked for a period of time. Veterinary pathologists and microbiologists must be aware of the limitations of some PCR assays when confronted with joint disease and pleuropneumonia in small ruminants.


Assuntos
Artrite/veterinária , Surtos de Doenças/veterinária , Doenças das Cabras/epidemiologia , Meningite/veterinária , Mycoplasma mycoides/isolamento & purificação , Pleuropneumonia Contagiosa/epidemiologia , Criação de Animais Domésticos , Animais , Animais Recém-Nascidos , Artrite/diagnóstico , Artrite/epidemiologia , Artrite/microbiologia , Feminino , Doenças das Cabras/diagnóstico , Doenças das Cabras/microbiologia , Cabras , Incidência , Masculino , Meningite/diagnóstico , Meningite/epidemiologia , Meningite/microbiologia , Missouri/epidemiologia , Pleuropneumonia Contagiosa/diagnóstico , Pleuropneumonia Contagiosa/microbiologia
11.
PLoS One ; 14(3): e0213244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845271

RESUMO

The 14-3-3 proteins are cerebrospinal fluid (CSF) markers of neuronal damage during infectious meningitis and Creutzfeldt-Jakob disease. Little is known about dynamic changes in the individual isoforms in response to parasitic eosinophilic meningitis. The purposes of this study were to determine the 14-3-3 protein isoform patterns, examine the kinetics and correlate the severity of blood brain barrier (BBB) damage with the expressions of these markers in mice with eosinophilic meningitis. Mice were orally infected with 50 A. cantonensis L3 via an oro-gastric tube and sacrificed every week for 3 consecutive weeks after infection. The Evans blue method and BBB junctional protein expressions were used to measure changes in the BBB. Hematoxylin and eosin staining was used to analyze pathological changes in the mice brains following 1-3 weeks of infection with A. cantonensis. The levels of 14-3-3 protein isoforms in serum/CSF and brain homogenates were analyzed by Western blot, and immunohistochemistry (IHC) was used to explore the different isoform distributions of 14-3-3 proteins and changes in BBB junctional proteins in the mice brain meninges. Dexamethasone was injected intraperitoneally from the seventh day post infection (dpi) until the end of the study (21 dpi) to study the changes in BBB junctional proteins. The amounts of Evans blue, tight junction and 14-3-3 protein isoforms in the different groups of mice were compared using the nonparametric Kruskal-Wallis test. There were significant increases in 14-3-3 protein isoforms ß and γ in the CSF in the second and third weeks after infection compared to the controls and first week of infection, which were correlated with the severity of BBB damage in brain histology, and Evans blue extravasation. Using IHC to assess the distribution of 14-3-3 protein isoforms and changes in BBB junctional proteins in the mice brain meninges, the expressions of isoforms ß, γ, ε, and θ and junctional proteins occludin and claudin-5 in the brain meninges increased over a 3-week period after infection compared to the controls and 1 week after infection. The administration of dexamethasone decreased the expressions of BBB junctional proteins occludin and claudin-5 in the mice brain meninges. Our findings support that 14-3-3 proteins ß and γ can potentially be used as a CSF marker of neuronal damage in parasitic eosinophilic meningitis caused by A. cantonensis.


Assuntos
Proteínas 14-3-3/metabolismo , Angiostrongylus cantonensis/patogenicidade , Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , Eosinofilia/metabolismo , Meningite/metabolismo , Infecções por Strongylida/metabolismo , Animais , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Barreira Hematoencefálica/parasitologia , Encéfalo/parasitologia , Modelos Animais de Doenças , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Feminino , Incidência , Masculino , Meningite/epidemiologia , Meningite/parasitologia , Camundongos , Camundongos Endogâmicos BALB C , Isoformas de Proteínas , Infecções por Strongylida/complicações , Infecções por Strongylida/parasitologia
13.
Acta Neurochir (Wien) ; 161(3): 517-524, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30666453

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) drainage or intracranial pressure (ICP) monitoring devices are life-saving devices. We examined the risk factors for infections related to them and assessed the effect of an infection control (IC) intervention. METHODS: A prospective observational study was conducted in the Neurosurgical Department of our hospital between 2014 and 2017. We included all consecutive patients undergoing CSF catheter insertions, including external ventricular drainage (EVD), lumbar drainage (LD), and ICP catheters. An IC intervention was implemented between March and August 2016. We examined risk factors for meningitis or ventriculitis, defined according to Healthcare-associated infections surveillance definitions, on univariate and multivariate analysis. RESULTS: A total of 232 patients with 437 drains (212 EVDs, 92 LDs, and 133 ICPs) were included. On univariate and multivariate analysis, the infection incidence was 13.7 per 1000 drain days (17.3/1000 before IC intervention, 7.9/1000 during, and 9.2/1000 after the intervention). Most episodes were caused by Gram-negative bacteria, and the most common pathogen was Acinetobacter baumanii. Risk factors for infection per patient included diabetes mellitus (p = 0.017), CSF leak (p = 0.032), drain opening (p = 0.027), and the duration of the drain in days (p = 0.035). Risk factors per catheter included drain opening (p < 0.001), drain days (p = 0.001), and the IC intervention period compared to before the intervention period (p = 0.037). When restricting the analysis to EVDs, drain days (p = 0.001) was the only significant risk factor. CONCLUSIONS: Strict adherence to IC, shortening drain duration, and avoiding unnecessary opening and manipulation of the drains are crucial to preventing neurosurgical drain infections.


Assuntos
Cateteres/microbiologia , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Infecção Hospitalar/etiologia , Drenagem/efeitos adversos , Pressão Intracraniana , Meningite/etiologia , Adulto , Cateteres/efeitos adversos , Estudos de Coortes , Infecção Hospitalar/microbiologia , Drenagem/instrumentação , Feminino , Bactérias Gram-Negativas/patogenicidade , Humanos , Masculino , Meningite/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
14.
Neurocrit Care ; 30(3): 666-674, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30523540

RESUMO

BACKGROUND/OBJECTIVE: Infection is the most common complication of external ventricular drain (EVD) placement. National trends in the annual incidence of meningitis among patients with traumatic brain injury (TBI) who have undergone EVD placement have not been reported. METHODS: The Nationwide Inpatient Sample was used to select adults with a primary diagnosis of TBI who underwent EVD placement between 2002 and 2011. Annual rates of meningitis among patients who underwent EVD placement were determined. We also calculated mortality rates and length of stay (LOS). Potential factors associated with meningitis were evaluated in a binary logistic regression analysis. RESULTS: Out of 1,571,927 adult discharges with a primary diagnosis of TBI between 2002 and 2011, 39,029 (2.5%) underwent EVD placement. Of these, 1544 (4.3%) patients developed meningitis. There was no significant trend in the annual incidence of meningitis (p = 0.88), mortality (p = 0.55), or mean LOS (p = 0.13) during the study period. Meningitis and mortality rates remained stable when stratifying patients by hospital volume. In the binary logistic regression, acquired immunodeficiency syndrome, sepsis, and cerebrospinal fluid leak were associated with meningitis. CONCLUSIONS: The incidence of meningitis in patients who underwent EVD placement remained stable between 2002 and 2011. Further prospective studies are needed to identify approaches for preventing these infections.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Meningite/epidemiologia , Meningite/etiologia , Alta do Paciente/estatística & dados numéricos , Ventriculostomia/efeitos adversos , Ventriculostomia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/epidemiologia , Bases de Dados Factuais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Incidência , Masculino , Meningite/mortalidade , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Clin Rheumatol ; 38(4): 1039-1046, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30483978

RESUMO

OBJECTIVES: Hypertrophic pachymeningitis (HP) is a rare complication in patients with anti-neutrophil antibody-associated vasculitis (AAV); its clinical features, incidence, and risk factors remain unknown. We aimed to clarify the prevalence, clinical features, and factors associated with new-onset HP in patients with AAV. METHOD: A retrospective cohort study involving 93 patients with AAV was conducted. HP incidence between patients with granulomatosis with polyangiitis (GPA) and those with microscopic polyangiitis (MPA) was compared to investigate risk factors associated with HP. We performed only univariate analysis using logistic regression and classification tree (CART) analysis due to the small number of HP cases. RESULTS: Among the 93 patients (76 with MPA and 17 with GPA), only 6 patients developed HP (1 with MPA, 5 with GPA) over an average observation period of 4 years; all patients who developed HP were positive for myeloperoxidase anti-neutrophil antibody. HP incidence was significantly higher in patients with GPA than in those with MPA (60.2 versus 3.3 persons per 1000 person-years, respectively, P = 0.002). The univariate analysis revealed that otitis media (P < 0.001) and sinusitis (P = 0.014) were associated with new-onset HP. Univariate CART analysis grouped the patients into patients with HP who have otitis media (33%) and patients with HP who have sinusitis (21%). The odds ratio of otitis media adjusted by age and first diagnosis of AAV was 38.1 (95% confidence interval, 3.08-331.4; P = 0.004). CONCLUSIONS: Although only in the univariate analysis, otitis media was the most discriminating factor to predict new-onset HP in patients with AAV.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/epidemiologia , Meningite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
Mycopathologia ; 184(1): 65-71, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415450

RESUMO

Cryptococcosis by Cryptococcus gattii occurs mainly in immunocompetent hosts, however, during the last decades, a growing number of cases in immunocompromised individuals have been noticed around the world. This report presents epidemiological, clinical and outcome aspects of patients with cryptococcosis caused by this species from a non-endemic area in Brazil. Of 278 Cryptococcus spp. clinical isolates recovered during the same period, 267 (96%) were molecularly identified as Cryptococcus neoformans VNI genotype and 11 (4%) as C. gattii VGII genotype by URA-5 RFLP. Of the 11 C. gattii patients, eight were male, mean age of 47.5 years. Of these, four were HIV-infected, one was kidney transplanted, one presented low CD4+ T cells values of unknown cause, another presented chronic liver disease meanwhile the remaining four were apparently immunocompetent. Disseminated disease and cryptococcal meningitis were present in four patients each. Most patients received amphotericin B plus fluconazole. Seven out of the 11 patients cured and four died before or during the therapy. The increased number of individuals with cryptococcosis by this species during the last decades needs to be carefully evaluated specially those who are HIV-infected. Nevertheless, Cryptococcus species differentiation is currently relevant in order to better know their relation with geographical, clinical host preference and outcome particularities.


Assuntos
Criptococose/epidemiologia , Criptococose/patologia , Cryptococcus gattii/isolamento & purificação , Adulto , Idoso , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Brasil/epidemiologia , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Cryptococcus gattii/classificação , Cryptococcus gattii/genética , DNA Fúngico/genética , Feminino , Fluconazol/administração & dosagem , Genótipo , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/patologia , Masculino , Meningite/tratamento farmacológico , Meningite/epidemiologia , Meningite/microbiologia , Meningite/patologia , Pessoa de Meia-Idade , Polimorfismo de Fragmento de Restrição , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
17.
J Microbiol Immunol Infect ; 52(5): 736-742, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29884448

RESUMO

PURPOSE: To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults. METHODS: Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR. RESULTS: A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcal polysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.


Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Sorogrupo , Adulto , Idoso , Antibacterianos/uso terapêutico , Cefotaxima/uso terapêutico , Cefalosporinas/uso terapêutico , Comorbidade , Farmacorresistência Bacteriana , Monitoramento Epidemiológico , Feminino , Humanos , Índia/epidemiologia , Masculino , Meningite/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mortalidade , Resistência às Penicilinas , Penicilinas/uso terapêutico , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/terapia , Vacinas Pneumocócicas , Pneumonia/epidemiologia , Prevalência , Estudos Prospectivos , Streptococcus pneumoniae/isolamento & purificação , Vacinas Conjugadas , Vancomicina/uso terapêutico , Adulto Jovem
18.
BJOG ; 126(3): 322-327, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29924919

RESUMO

BACKGROUND: Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects. OBJECTIVE: To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared with caesarean delivery. SEARCH STRATEGY: Electronic databases MEDLINE, EMBASE, Scopus, and Clinicaltrials.gov were searched from inception to November 2017. SELECTION CRITERIA: Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair. DATA COLLECTION AND ANALYSIS: Two reviewers independently reviewed abstracts and full-text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus exposure to labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% CI were calculated. MAIN RESULTS: Of 201 abstracts identified in the primary search, nine studies (672 women) met the eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58 to 0.38; I2  = 57%). The vaginal delivery group was less likely to require a shunt or have sac disruption [odds ratio (OR) 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively]. Comparisons by prelabour caesarean versus exposure to labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI 0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12). CONCLUSION: Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects. TWEETABLE ABSTRACT: Available evidence does not support routine caesarean delivery for fetuses with open neural tube defects.


Assuntos
Parto Obstétrico/métodos , Meningocele , Meningomielocele , Derivações do Líquido Cefalorraquidiano/estatística & dados numéricos , Cesárea/métodos , Gerenciamento Clínico , Feminino , Humanos , Trabalho de Parto , Meningite/epidemiologia , Defeitos do Tubo Neural/terapia , Complicações do Trabalho de Parto/epidemiologia , Razão de Chances , Gravidez , Caminhada
19.
Parasitology ; 146(1): 42-49, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29925459

RESUMO

Angiostrongylus cantonensis (rat lungworm), a parasitic nematode, is expanding its distribution. Human infection, known as angiostrongyliasis, may manifest as eosinophilic meningitis, an emerging infectious disease. The range and incidence of this disease are expanding throughout the tropics and subtropics. Recently, the Hawaiian Islands have experienced an increase in reported cases. This study addresses factors affecting the parasite's distribution and projects its potential future distribution, using Hawaii as a model for its global expansion. Specimens of 37 snail species from the Hawaiian Islands were screened for the parasite using PCR. It was present on five of the six largest islands. The data were used to generate habitat suitability models for A. cantonensis, based on temperature and precipitation, to predict its potential further spread within the archipelago. The best current climate model predicted suitable habitat on all islands, with greater suitability in regions with higher precipitation and temperatures. Projections under climate change (to 2100) indicated increased suitability in regions with estimated increased precipitation and temperatures, suitable habitat occurring increasingly at higher elevations. Analogously, climate change could facilitate the spread of A. cantonensis from its current tropical/subtropical range into more temperate regions of the world, as is beginning to be seen in the continental USA.


Assuntos
Angiostrongylus cantonensis/isolamento & purificação , Caramujos/parasitologia , Infecções por Strongylida/epidemiologia , Angiostrongylus cantonensis/genética , Animais , Área Sob a Curva , Mudança Climática , Ecossistema , Eosinofilia/epidemiologia , Eosinofilia/parasitologia , Sistemas de Informação Geográfica , Saúde Global , Hawaii/epidemiologia , Humanos , Modelos Lineares , Meningite/epidemiologia , Meningite/parasitologia , Modelos Biológicos , Reação em Cadeia da Polimerase , Chuva , Análise de Regressão , Caramujos/classificação , Infecções por Strongylida/parasitologia , Temperatura Ambiente
20.
Neurol Sci ; 40(1): 81-88, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30255486

RESUMO

BACKGROUND: Acute meningitis and encephalitis (AME) is a syndrome of central nervous system (CNS) infections, which could lead to neurological damage and fatality. This study evaluates the multiplex FilmArray® ME Panel which is aimed to diagnose agents causing suspect CNS infections in north India. METHODS: A total number of 969 cerebrospinal fluid (CSF) samples collected between August 2016 and January 2018 from patients who showed clinical symptoms of CNS infections were analyzed using the FilmArray® ME Panel. Also a comparison of molecular diagnosis and various laboratory and radiological findings for Streptococcus pneumoniae, Enterovirus and Cryptococcus neoformans positive cases was done. RESULT: Out of the 969 CSF samples, 101 cases were found to be positive for viral (n = 55), bacterial (n = 38), fungal (n = 7), and poly-microbial (n = 1) agents. Out of the 55 viral positive cases, the most detected pathogen was Enterovirus (n = 23) with predominance in the age group of 2-17 years, followed by Varicella Zoster virus (n = 14) and HSV1(n = 9) cases. Streptococcus pneumoniae (n = 26) was found to be the predominant bacterial pathogen, of which 17 were detected in the age group above 35 years. Cryptococcus neoformans was found in 7 cases. CONCLUSION: The FilmArray® ME Panel aids in rapid detection of 14 pathogens directly from CSF. When compared to gram stain, culture, antigen detection, and CSF biochemical analysis, the FilmArray® ME Panel has detected more cases, some of which are difficult to diagnose by conventional methods. This rapid technology will help the clinicians in case of early patient management, outcomes and provide aid in antimicrobial stewardship.


Assuntos
Encefalite/líquido cefalorraquidiano , Encefalite/diagnóstico , Meningite/líquido cefalorraquidiano , Meningite/diagnóstico , Centros de Atenção Terciária/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/diagnóstico , Infecções do Sistema Nervoso Central/epidemiologia , Criança , Pré-Escolar , Encefalite/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Meningite/epidemiologia , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
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