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2.
Medicine (Baltimore) ; 100(3): e24028, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546000

RESUMO

RATIONALE: Bronchial involvement alone is a rare initial manifestation of granulomatosis with polyangiitis (GPA). Herein, we report a case of refractory GPA with obstructive pneumonia caused by bronchial involvement. PATIENT CONCERNS: A 65-year-old man complained of a 2-week cough and fever. DIAGNOSES: Considering the presence of opacities and multiple consolidations in both lungs due to obstruction or stenosis on the bronchus, which did not respond to antibiotics, and proteinase-3-antineutrophil cytoplasmic autoantibody positivity, he was diagnosed with GPA. Positron emission tomography- computed tomography scan revealed no abnormal findings in the upper respiratory tract. INTERVENTIONS: He was treated with prednisolone (PSL, 50 mg/d) and intravenous cyclophosphamide. OUTCOMES: His general and respiratory symptoms improved. However, 8 weeks after PSL treatment at 20 mg/d, he developed a relapse of vasculitis along with sinusitis and hypertrophic pachymeningitis. Hence, PSL treatment was resumed to 50 mg/d, and weekly administration of rituximab was initiated. Consequently, the symptoms gradually mitigated. LESSONS: GPA with bronchial involvement is often intractable and requires careful follow-up, which should include upper respiratory tract and hypertrophic pachymeningitis assessment.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Granulomatose com Poliangiite/complicações , Meningite/etiologia , Pneumonia/etiologia , Idoso , Brônquios/patologia , Progressão da Doença , Humanos , Hipertrofia , Masculino
3.
Medicine (Baltimore) ; 100(3): e24388, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546079

RESUMO

RATIONALE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can involve the central nervous system in estimatedly 15% of patients. Hypertrophic pachymeningitis causes inflammatory hypertrophy of the cranial or spinal dura mater and patients present with various neurological deficits. ANCA-associated hypertrophic spinal pachymeningitis has rarely been reported in literature. We report a case of AAV presenting with hypertrophic spinal pachymeningitis detected by 18F-FDG PET/CT. PATIENT CONCERNS: A 66-year-old woman diagnosed with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis developed back pain, bilateral lower limb weakness, dysuria, and dysporia 1 month ago. DIAGNOSIS: Contrast-enhanced MRI showed thickening and enhancement of the dura mater in the thoracic cord. Intraspinal hypermetabolism in the corresponding region was observed on 18F-FDG PET/CT. The patient was finally diagnosed with ANCA-associated hypertrophic spinal pachymeningitis. INTERVENTIONS: The patient was treated with a higher dose of prednisone and cyclophosphamide. OUTCOMES: After 2-week treatment, the patient's neurological symptoms improved rapidly and laboratory findings were ameliorated. A repeated contrast-enhanced MRI showed partial improvement of the disease in the thoracic cord. LESSONS: 18F-FDG PET/CT and contrast-enhanced MRI can aid in the clinical diagnosis and surveillance in AAV-associated hypertrophic spinal pachymeningitis and potentially facilitate early recognition and intervention to prevent irreversible neurological impairment.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Meningite/etiologia , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18/uso terapêutico , Humanos , Meningite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos
4.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1150416

RESUMO

Objetivo: Analisar o perfil epidemiológico da meningite em crianças no Brasil. Método: Trata-se de estudo descritivo, cujos dados foram obtidos através de análise documental do Departamento de Informática do Sistema Único de Saúde (DATASUS) por meio de dados disponibilizados pela notificação no Sistema de Informação e Agravos de Notificação (Sinan). Foram utilizados dados da notificação de meningite no período de 2008 a 2019, em crianças até os 14 anos de idade no país. Resultados: Na faixa etária pediátrica, foram notificados 127.508 casos, o equivalente a 55,83% de todos os diagnósticos realizados neste período em todas as faixas etárias. Na amostra, houve maior prevalência da faixa etária entre 1 ano a 4 anos. Em relação ao sexo, o masculino foi o mais prevalente. Quanto à evolução dos casos notificados, a maioria dos pacientes tiveram alta hospitalar. Destes, a faixa etária entre 1 a 4 anos obteve maior prevalência. Quanto aos óbitos por meningite, houve maior prevalência da faixa etária de menores de 1 ano. O método quimiocitológico foi o método diagnóstico mais utilizado, evidenciando principalmente a meningite de etiologia viral. Conclusão: Verifica-se que os casos de meningite são prevalentes na faixa etária pediátrica, havendo predomínio da faixa etária entre 1 a 4 anos e do sexo masculino neste estudo. Ressalta-se a importância de ações preventivas, como a imunização vacinal, sobretudo quando se percebe a maior letalidade da meningite bacteriana


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Meningite/epidemiologia , Brasil/epidemiologia , Hospitalização/estatística & dados numéricos , Meningite/diagnóstico , Meningite/etiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-33053146

RESUMO

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


Assuntos
Meningite/epidemiologia , Meningoencefalite/epidemiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Adolescente , Adulto , Criança , Colômbia/epidemiologia , Feminino , Humanos , Masculino , Meningite/etiologia , Meningoencefalite/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
7.
Rinsho Shinkeigaku ; 60(9): 631-635, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779602

RESUMO

We report a 62-year-old female with rheumatoid meningitis. She presented with mental disorder, loss of consciousness, generalized seizures, and cognitive impairment. Brain MRI demonstrated high intensity lesions and abnormal enhancement along the left frontal and parietal sulci. Her serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptides (CCP) antibody, and the antibody index of cerebrospinal fluid anti-CCP antibody increased, which led us to suspect rheumatoid meningitis. Her symptoms improved immediately by methylpredonisolone pulse therapy and anti-CCP antibody turned negative in cerebrospinal fluid. However, she revealed arthritis with the reduction of betamethasone and was diagnosed as rheumatoid arthritis. We suggest that the elevation of antibody index of cerebrospinal fluid anti-CCP antibody is useful in the diagnosis of rheumatoid meningitis preceding neurological symptoms without arthritis, and anti-CCP antibody in cerebrospinal fluid may be helpful as the evaluation of the treatment.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Autoanticorpos/líquido cefalorraquidiano , Meningite/diagnóstico , Meningite/etiologia , Doenças do Sistema Nervoso/etiologia , Peptídeos Cíclicos/imunologia , Artrite Reumatoide/tratamento farmacológico , Biomarcadores/líquido cefalorraquidiano , Feminino , Humanos , Meningite/tratamento farmacológico , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/tratamento farmacológico , Pulsoterapia , Resultado do Tratamento
9.
Rinsho Shinkeigaku ; 60(7): 500-503, 2020 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-32536662

RESUMO

A 66-year-old woman presented with dysesthesia over the right side of her face, hypoglossal nerve dysfunction, dysphagia, and dysgeusia of the right side. A MRI scan of the brain revealed cerebral dural thickening on the right side of the skull base, and histopathological examination revealed granulomatous inflammation of the dura. Based on paranasal sinusitis, bronchodilatation, laboratory tests showing weakly positive MPO-ANCA, intact renal function, and the patient's favorable response to steroids, we diagnosed the patient with limited granulomatosis with polyangiitis (GPA). Reportedly, autoimmune disease might occur in patients with exacerbation of monoclonal gammopathy of undetermined significance, which was observed in this case. This suggests the utility of immunoelectrophoresis.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Meningite/diagnóstico , Meningite/etiologia , Gamopatia Monoclonal de Significância Indeterminada/complicações , Gamopatia Monoclonal de Significância Indeterminada/diagnóstico , Peroxidase/imunologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Progressão da Doença , Feminino , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Humanos , Hipertrofia , Meningite/tratamento farmacológico , Meningite/patologia , Metilprednisolona/administração & dosagem , Gamopatia Monoclonal de Significância Indeterminada/tratamento farmacológico , Gamopatia Monoclonal de Significância Indeterminada/patologia , Prednisolona/administração & dosagem , Resultado do Tratamento
10.
Nat Commun ; 11(1): 3159, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32572022

RESUMO

Extravasated erythrocytes in cerebrospinal fluid (CSF) critically contribute to the pathogenesis of subarachnoid hemorrhage (SAH). Meningeal lymphatics have been reported to drain macromolecules and immune cells from CSF into cervical lymph nodes (CLNs). However, whether meningeal lymphatics are involved in clearing extravasated erythrocytes in CSF after SAH remains unclear. Here we show that a markedly higher number of erythrocytes are accumulated in the lymphatics of CLNs and meningeal lymphatics after SAH. When the meningeal lymphatics are depleted in a mouse model of SAH, the degree of erythrocyte aggregation in CLNs is significantly lower, while the associated neuroinflammation and the neurologic deficits are dramatically exacerbated. In addition, during SAH lymph flow is increased but without significant lymphangiogenesis and lymphangiectasia. Taken together, this work demonstrates that the meningeal lymphatics drain extravasated erythrocytes from CSF into CLNs after SAH, while suggesting that modulating this draining may offer therapeutic approaches to alleviate SAH severity.


Assuntos
Sistema Linfático/patologia , Meninges/patologia , Hemorragia Subaracnóidea/patologia , Animais , Lesões Encefálicas , Eritrócitos , Linfonodos/fisiopatologia , Linfangiogênese , Vasos Linfáticos/fisiopatologia , Masculino , Meningite/etiologia , Meningite/patologia , Camundongos , Camundongos Endogâmicos C57BL , Modelos Animais , Pescoço , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Receptor 3 de Fatores de Crescimento do Endotélio Vascular/metabolismo
11.
Saudi Med J ; 41(6): 652-656, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518934

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is rare disease entity and has recently been recognized as an inflammatory disorder with the tendency to affect multiple organs. Pachymeningitis of spine caused by IgG4-related disease is extremely rare. Neck pain and spinal cord compression symptoms consist of usual presentation of IgG4-related spinal pachymeningitis; however, polyarthritis is an unusual presentation of this disease, and it was reported in only one case that mimicked psoriatic arthritis. In this report, we describe a case of IgG4-related spinal pachymeningitis in a middle-age male who presented initially with neck pain and  rheumatoid arthritis-like symptoms and later on developed both right upper and lower limb weakness. He was found to had pachymeningeal thickening on a cervical magnetic resonance image (MRI) and elevated serum IgG4 levels. He was treated with glucocorticoids and rituximab, which led to a significantly positive radiological response.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Meningite/etiologia , Adulto , Artrite Reumatoide/etiologia , Biomarcadores/sangue , Vértebras Cervicais , Extremidades , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Imagem por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningite/tratamento farmacológico , Debilidade Muscular/etiologia , Cervicalgia/etiologia , Rituximab/uso terapêutico , Compressão da Medula Espinal/etiologia , Resultado do Tratamento
12.
Rinsho Shinkeigaku ; 60(6): 429-433, 2020 Jun 06.
Artigo em Japonês | MEDLINE | ID: mdl-32435045

RESUMO

We report a case of rheumatoid meningitis complicated with cryptococcal meningitis in a 59-year-old female with rheumatoid arthritis. Migraine symptoms were followed by abnormal behavior, and the patient was admitted with fever and headache. On admission, her cerebrospinal fluid (CSF) contained 115 cells/µl, a protein content of 95 mg/dl, and a sugar level of 47 mg/dl; Her serum anti-cyclic citrullinated peptide (CCP) antibody value was high (174 U/ml), and a brain MRI showed enhanced gadolinium lesions in the cerebral/cerebellar pia mater and subarachnoid space, etc. Probable rheumatoid meningitis was clinically diagnosed, and a prednisolone (PSL) pulse was started. Several days later, a CSF culture test was positive for Cryptococcus neoformans, and the antigen titer was 128-fold. Liposomal-amphotericin B (L-AMB) was started for cryptococcal meningitis, combined with three PSL pulses for rheumatoid meningitis. After about 4 weeks, the number of CSF cells and anti-CCP antibodies decreased rapidly. At 2 months after the onset, the meningitis recurred. The MRI contrast lesions reappeared, and the CSF cells increased to 24/µl. Serum and CSF anti-CCP antibodies increased at the time of recurrence, but the cryptococcal antigen titer decreased. Thus, we concluded that the rheumatoid meningitis mainly involved the pathogenesis of both types of meningitis. The number of PSL pulses was limited to four. Post-perioral therapy was avoided. Methotrexate was continued for the rheumatoid meningitis, fluconazole was continued for the cryptococcal meningitis, and neither type of meningitis has recurred.


Assuntos
Artrite Reumatoide/complicações , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/etiologia , Meningite/diagnóstico , Meningite/etiologia , Anticorpos/sangue , Anticorpos/líquido cefalorraquidiano , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Meningite/tratamento farmacológico , Meningite Criptocócica/tratamento farmacológico , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Peptídeos Cíclicos/imunologia , Prednisolona/administração & dosagem , Resultado do Tratamento
14.
World Neurosurg ; 137: 98-101, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035199

RESUMO

BACKGROUND: Rheumatoid meningitis is a rare manifestation of autoimmune rheumatoid arthritis. CASE DESCRIPTION: A 70-year-old man with rheumatoid arthritis had presented with speech difficulties and limb weakness. Magnetic resonance imaging of his brain demonstrated diffuse meningeal enhancement. A biopsy confirmed the presence of rheumatoid meningitis. CONCLUSION: In the present report, we have discussed the diagnostic and therapeutic approach to rheumatoid meningitis.


Assuntos
Artrite Reumatoide/patologia , Encéfalo/patologia , Meningite/patologia , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/etiologia , Biópsia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Meningite/diagnóstico , Meningite/etiologia
15.
BMC Neurol ; 20(1): 56, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32061247

RESUMO

BACKGROUND: Craniopharyngiomas are defined by the WHO as "benign" tumours, but their location and surgical treatment may be associated with major complications, one being chemical meningitis. Although rare, especially in children, it should be taken into account when worrying symptoms appear after surgery. CASE PRESENTATION: The aim of this study is to present the case of chemical meningitis in a 7-year-old girl. She was admitted to the Department of Neurology with the following symptoms: headache, vomiting and balance disorders. Brain magnetic resonance imaging showed a tumour in the sellar and suprasellar region, which was diagnosed as a craniopharyngioma. Due to acute hydrocephalus the patient underwent emergency surgery. Conventional surgery was preceded by an endocrinological consultation to determine pituitary hormone levels. The first 6 days post-surgery, during which the patient started substitution therapy for pituitary insufficiency, were uneventful but on the seventh day she presented with seizures, fever, severe headache, weakness, irritability, stiffening of the neck and a gradual degradation of consciousness. This clinical presentation suggested meningitis, which was confirmed by examination of cerebrospinal fluid. CONCLUSIONS: The conventional and/or endoscopic resection of a craniopharyngioma poses a risk of postoperative complications in the form of chemical meningitis. Although this is a rare occurrence in children with craniopharyngioma, physicians should be aware of this complication and its clinical presentation as it may facilitate earlier diagnosis, appropriate treatment and a faster recovery of their patients.


Assuntos
Craniofaringioma/complicações , Meningite/etiologia , Neoplasias Hipofisárias/complicações , Criança , Craniofaringioma/cirurgia , Feminino , Cefaleia/etiologia , Humanos , Hidrocefalia/cirurgia , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
16.
Int J Mol Sci ; 21(5)2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32106601

RESUMO

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


Assuntos
Pneumonia Associada a Assistência à Saúde/sangue , Interleucina-10/sangue , Meningite/sangue , Hemorragia Subaracnóidea/sangue , Idoso , Biomarcadores/sangue , Feminino , Pneumonia Associada a Assistência à Saúde/epidemiologia , Pneumonia Associada a Assistência à Saúde/etiologia , Humanos , Aneurisma Intracraniano/sangue , Aneurisma Intracraniano/complicações , Masculino , Meningite/epidemiologia , Meningite/etiologia , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/etiologia
17.
J Laryngol Otol ; 134(1): 46-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31858918

RESUMO

BACKGROUND: Ecchordosis physaliphora is a congenital, benign lesion originating from notochordal remnants along the craniospinal axis, most frequently located at the level of the clivus and sacrum. Sometimes ecchordosis physaliphora is difficult to recognise and treat, with a total of twenty-six cases described in the literature. METHODS: This study reports on three cases of previously undiagnosed ecchordosis physaliphora presenting with cerebrospinal fluid rhinorrhoea and meningitis. CONCLUSION: Endoscopic transclival or transsphenoid surgery including three-layer (fat, fascia and nasoseptal flap) reconstruction was used in all cases with complete resolution of the symptoms.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/etiologia , Hamartoma/cirurgia , Meningite/etiologia , Idoso de 80 Anos ou mais , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Feminino , Hamartoma/diagnóstico por imagem , Humanos , Masculino , Meningite/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Notocorda/diagnóstico por imagem , Notocorda/patologia , Notocorda/cirurgia
18.
Pediatr Infect Dis J ; 39(1): 35-40, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31738319

RESUMO

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


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Meningite/epidemiologia , Sepse/epidemiologia , Comorbidade , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Meningite/etiologia , Sepse/etiologia
19.
Clin Microbiol Infect ; 26(3): 281-290, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31760115

RESUMO

BACKGROUND: The FilmArray® meningitis/encephalitis (ME) panel is a multiplex PCR assay which can detect the most commonly identified pathogens in central nervous system infections. It significantly decreases the time to diagnosis of ME and data has yielded several positive outcomes. However, in part, reports of both false positive and false negative detections have resulted in concerns about adoption. OBJECTIVES: The aim was to evaluate the ME panel in a diagnostic test accuracy review. DATA SOURCES: The PubMed and EMBASE databases were systematically searched through May 2019. STUDY ELIGIBILITY CRITERIA: Eligible studies were those providing sensitivity and specificity data for the ME panel compared with a reference standard. Studies providing details on false positive and false negative results of the panel as well as further investigation (adjudication) of the discordant results between the panel and comparator assays were included and assessed separately. PARTICIPANTS: Patients with suspected ME for whom a panel was ordered were included. METHODS: The ME panel was compared to reference standard methods for diagnosing community-acquired ME. We performed a meta-analysis and calculated the summary sensitivity and specificity of the ME panel. Moreover, we evaluated the false positive and false negative results of the panel. RESULTS: Thirteen studies (3764 patients) were included in the review and 8 of them (3059 patients) were pooled in a meta-analysis. The summary estimates of sensitivity and specificity with 95% confidence intervals (CI) was 90% (95% CI 86-93%) and 97% (95% CI 94-99%), respectively. When we looked specifically at studies that assessed further the false positive and false negative results, false positive detections were 11.4% and 4% before and after adjudication, respectively. The highest proportion of false positive was observed for Streptococcus pneumoniae followed by Streptococcus agalactiae. False negative isolates were 2.2% and 1.5% before and after adjudication, respectively. Herpes simplex virus 1 and 2, enterovirus and Cryptococcus neoformans/gattii had the highest proportions of false negative determinations. False negative C. neoformans/gattii were mostly patients with positive antigen titres, on treatment or cleared disease. CONCLUSIONS: The currently available literature suggests that the ME panel has high diagnostic accuracy. However, the decision for implementation should be individualized based on the needs of the patient population, the capabilities of the laboratory, and the knowledge of the healthcare providers that will utilize the test.


Assuntos
Encefalite/diagnóstico , Meningite/diagnóstico , Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase Multiplex/normas , Kit de Reagentes para Diagnóstico , Encefalite/etiologia , Humanos , Meningite/etiologia , Viés de Publicação , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Int J Pediatr Otorhinolaryngol ; 128: 109696, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31585355

RESUMO

BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, p < 0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], p < 0.001) but similar LOS (12 [10] v 11 [9] days, p = 0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.


Assuntos
Doenças do Sistema Nervoso Central/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças Orbitárias/economia , Rinite/complicações , Sinusite/complicações , Doença Aguda , Adolescente , Abscesso Encefálico/economia , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/cirurgia , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Meningite/economia , Meningite/etiologia , Meningite/cirurgia , Procedimentos Neurocirúrgicos/economia , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Trombose dos Seios Intracranianos/economia , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/cirurgia
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