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2.
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
4.
World Neurosurg ; 132: 173-176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491571

RESUMO

BACKGROUND: Epidermoid cysts of the spinal cord may rupture, resulting in keratin dissemination in the subarachnoid space, in the ventricles, and along the central canal of the spinal cord causing meningitis, myelopathic changes, or hydrocephalus. CASE DESCRIPTION: A 53-year-old woman with no past medical history presented with a 2-week history of headache located in the occipital region associated with neck pain. Brain magnetic resonance imaging demonstrated multiple fat droplets scattered throughout the subarachnoid and intraventricular spaces with significant edema of the right posterior temporoparietal lobes with trapping of the right temporal horn of the lateral ventricle and atrium. An intracranial lesion could not be observed in the study. The spinal region was suspected as the possible culprit, and spinal imaging showed a large cystic lesion at the level of the conus medullaris. The patient underwent neuronavigation endoscopic exploration of the right lateral ventricle with flushing of the keratin particles followed by a posterior lumbar decompression with resection of the epidermoid cyst. Pathology was consistent with an epidermoid cyst. Successful recovery with improvement in symptoms was quickly observed. CONCLUSIONS: When an epidermoid cyst is suspected but no intracranial lesion is found, the intraspinal area should be studied. Rupture of a spinal epidermoid cyst may cause meningitis and inflammation producing obstructive hydrocephalus. We present this rare entity and describe the diagnostic and surgical techniques used.


Assuntos
Cisto Epidérmico/complicações , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Meningite/etiologia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/complicações , Ventrículos Cerebrais/metabolismo , Ventrículos Cerebrais/patologia , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Queratinas/metabolismo , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuronavegação , Ruptura , Espaço Subaracnóideo/metabolismo , Espaço Subaracnóideo/patologia , Resultado do Tratamento
5.
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
6.
J Int Adv Otol ; 15(2): 313-316, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257190

RESUMO

Cerebrospinal fluid (CSF) rhinorrhea is not an uncommon condition, and it may lead to recurrent attacks of meningitis. The detection of the leakage site is an essential part of the investigations performed for the patient. In some cases, an anterior skull base site cannot be detected despite continuous leakage. In these cases, a more distal site must be sought. Furthermore, in some cases, the leakage occurs in the temporal bone. In such patients, a history of hearing loss or previous ear complaints indicates a hidden CSF otorhinorrhea. We present two adult cases of congenital hearing loss due to unilateral inner ear anomalies who presented later in life with repeated meningitis attacks and CSF otorhinorrhea.


Assuntos
Otorreia de Líquido Cefalorraquidiano/complicações , Rinorreia de Líquido Cefalorraquidiano/complicações , Meningite/etiologia , Espaço Subaracnóideo , Adulto , Orelha Interna/anormalidades , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Imagem por Ressonância Magnética , Meningoencefalite/etiologia , Seios Paranasais , Recidiva , Osso Temporal , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
PLoS One ; 14(7): e0217253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276518

RESUMO

OBJECTIVE: Meningitis after microsurgery for vestibular schwannoma (VS) is a severe complication that results in high morbidity. However, few studies have focused on meningitis after VS surgery. The purpose of this study was to identify the risk factors for meningitis after VS surgery. METHODS: We performed a retrospective analysis of all VS patients who underwent microsurgery and survived for at least 7 days after surgery, between 1 June 2015 and 30 November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM). RESULTS: We enrolled 410 patients, 27 of whom had POM. Through univariate analysis, the factors of hydrocephalus (p = 0.018), Koos grade IV (p = 0.04), operative duration > 3 hours (p = 0.03) and intraoperative bleeding volume ≥400 ml (p = 0. 02) were significantly correlated with POM. The multivariate analysis showed that Koos grade IV (p = 0.04; OR = 3.19; 95% CI 1.032-3.190), operation duration > 3 hours (p = 0.03; OR = 7.927; 95% CI 1.043-60.265), and intraoperative bleeding volume ≥ 400 ml (p = 0.02; OR = 2.551; 95% CI 1.112-5.850) were the independent influencing factors of POM. CONCLUSIONS: Koos grade IV, operation duration > 3 hours, and intraoperative blood loss ≥ 400 ml were identified as independent risk factors for POM after microsurgery for VS. POM also caused a prolonged hospital stay.


Assuntos
Perda Sanguínea Cirúrgica , Imagem por Ressonância Magnética , Meningite , Microcirurgia/efeitos adversos , Neuroma Acústico , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Meningite/diagnóstico por imagem , Meningite/epidemiologia , Meningite/etiologia , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/epidemiologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
9.
Lupus ; 28(9): 1154-1157, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31333063

RESUMO

Hypertrophic pachymeningitis (HP) is a relatively uncommon disease associated with focal or diffuse thickening of the dura mater secondary to underlying chronic inflammation. The link between systemic lupus erythematosus (SLE) and hypertrophic pachymeningitis (HP) is extremely rare, with only six other cases reported in the literature. We, however, report the first case of SLE pachymeningitis presenting with multiple cranial nerve palsies. The patient showed good response to steroids and cyclophosphamide therapy. One should maintain a high index of suspicion to make the diagnosis in patients with SLE presenting with neurological dysfunction. Prompt therapy prevents long-term neurological sequelae.


Assuntos
Doenças dos Nervos Cranianos/etiologia , Lúpus Eritematoso Sistêmico/complicações , Meningite/etiologia , Doenças dos Nervos Cranianos/tratamento farmacológico , Ciclofosfamida/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Meningite/tratamento farmacológico , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Rinsho Shinkeigaku ; 59(8): 520-524, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341127

RESUMO

A 93-year-old man was admitted to our hospital with disturbance of consciousness. Brain magnetic resonance imaging (MRI) showed hyperintensity of the subarachnoid space in the left frontal and parietal lobes on diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR). Gadolinium-enhancement of the pia mater was also observed. We did not perform biopsy because of a high risk of perioperative complication. Although physical examination found no evidence of the rheumatoid arthritis, rheumatoid factors and anti-cyclic citrullinated peptides antibodies were elevated. He was suspected to have rheumatoid meningitis. We treated him with intravenous methylprednisolone (0.5 g/day) for 3 days. Rheumatoid meningitis often shows hyperintensity of the subarachnoid space on the DWI and FLAIR, and steroid therapy is effective.


Assuntos
Artrite Reumatoide/complicações , Meningite/tratamento farmacológico , Meningite/etiologia , Metilprednisolona/administração & dosagem , Fatores Etários , Idoso de 80 Anos ou mais , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Biomarcadores/sangue , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Humanos , Masculino , Meningite/diagnóstico , Meningite/diagnóstico por imagem , Pulsoterapia , Fator Reumatoide/sangue , Resultado do Tratamento
11.
BMJ Case Rep ; 12(6)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31256046

RESUMO

Dorsal dermal sinus (DDS) represents the spectrum of spinal dysraphism. Children may present with features of meningitis. A 13-month male child presented with features of meningitis and quadriparesis. Clinical examination revealed a small pit over the thoracic spine. MRI was suggestive of a DDS. Initially, the patient responded to antibiotics and methylprednisolone, which was given for resolving the mass effect. However, he had a recurrence of symptoms and underwent surgical exploration and resection of DSS with resolution of symptoms. Careful examination of the back is extremely essential in children with meningitis. Radiological investigation helps in visualisation of the DSS. Although rare in children, they may present with recurrent meningitis.


Assuntos
Imagem por Ressonância Magnética/métodos , Quadriplegia , Espinha Bífida Oculta/diagnóstico por imagem , Espinha Bífida Oculta/cirurgia , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Meningite/etiologia , Espinha Bífida Oculta/complicações , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
12.
Rinsho Shinkeigaku ; 59(7): 436-441, 2019 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-31243250

RESUMO

We report a 54-year-old man, who presented with an acute onset of diplopia and ptosis on the left side. On admission, neurological examination showed left oculomotor and abducens nerve palsy. Brain MRI showed thickening of the left parieto-temporal dura mater with gadolinium enhancement. Whole-body CT revealed a mass lesion in the right submandibular gland, diffuse goiter, and bilateral hilar lymph node enlargement. Initially, IgG4-related disease was considered because of an elevated serum IgG4 level (240 mg/dl); however, biopsy of the submandibular gland showed non-caseating epithelioid cell granulomas that suggested sarcoidosis, which could be associated with the intracranial lesions causing his neurological manifestation. In cases of hypertrophic pachymeningitis, especially with increased serum IgG4 including our case, a careful assessment with pathological examination is critical for identifying various underlying conditions.


Assuntos
Hipergamaglobulinemia/sangue , Hipergamaglobulinemia/etiologia , Imunoglobulina G/sangue , Meningite/etiologia , Sarcoidose/complicações , Sarcoidose/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Humanos , Hipertrofia , Imagem por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningite/patologia , Sarcoidose/patologia , Glândula Submandibular/diagnóstico por imagem , Glândula Submandibular/patologia
13.
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
15.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(1): 98-104, 2019 Mar 16.
Artigo em Chinês | MEDLINE | ID: mdl-31016931

RESUMO

Angiostrongylosis, a food-borne parasitic disease, is caused by the migration of larvae of Angiostrongylus cantonensis to the host's central nervous system after it is infected. It is a serious disease with eosinophilic encephalitis and meningoencephalitis as the main clinical manifestations. Understanding of its pathogenic mechanism is important for the prevention and treatment of angiostrongylosis. This paper reviews the mechanism of eosinophilic meningitis and meningoencephalitis caused by A. cantonensis infection.


Assuntos
Angiostrongylus cantonensis , Meningite , Infecções por Strongylida , Animais , Humanos , Larva , Meningite/tratamento farmacológico , Meningite/etiologia , Meningite/parasitologia , Infecções por Strongylida/tratamento farmacológico , Infecções por Strongylida/parasitologia , Infecções por Strongylida/patologia , Infecções por Strongylida/prevenção & controle
16.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948395

RESUMO

An 87-year-old woman with quiescent rheumatoid arthritis, not on immunosuppressive therapy, presented with unilateral arm weakness, confusion and visual hallucinations. There were no infective symptoms or history of malignancy. Cerebrospinal fluid (CSF) analysis demonstrated lymphocytosis and raised protein, without flow cytometric or cytological abnormalities. Viral, bacterial, mycobacterial and fungal testing of CSF and serum were negative. MRI brain indicated unilateral leptomeningeal enhancement. There was no evidence of occult malignancy on CT imaging of the chest, abdomen and pelvis. Rheumatoid factor and anticyclic citrullinated peptide were strongly positive. The patient declined meningeal biopsy but responded to treatment with corticosteroid therapy.


Assuntos
Artrite Reumatoide/complicações , Meningite/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos
17.
Emerg Infect Dis ; 25(5): 898-910, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31002063

RESUMO

During 2003-2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.


Assuntos
Infecções do Sistema Nervoso Central/etiologia , Adolescente , Adulto , Infecções do Sistema Nervoso Central/diagnóstico , Infecções do Sistema Nervoso Central/tratamento farmacológico , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Feminino , Política de Saúde , Humanos , Lactente , Encefalite Infecciosa/etiologia , Encefalite Infecciosa/microbiologia , Encefalite Infecciosa/virologia , Laos , Masculino , Meningite/etiologia , Meningite/microbiologia , Meningite/virologia , Estudos Prospectivos , Adulto Jovem
18.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(2): 174-178, 2019 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-30744292

RESUMO

Objective: To characterize the etiology and epidemiological characteristics of the acute meningitis and encephalitis syndrome (AMES) in Jinan city in 2013-2016. Methods: The epidemiological data, clinical diagnosis, serum and cerebrospinal fluid (CSF) specimens were collected from 3 577 AMES cases in 6 sentinel hospitals in Jinan city in 2013-2016. Samples of all cases were made sero-diagnosis for Immunoglobulin (Ig) M antibody to Japanese encephalitis virus (JEV) and negative cases of JEV for enterovirus (EV), mumps virus (MuV) and herpes simplex virus (HSV) by enzyme-linked immunosorbent assay (ELISA). Virus isolation and molecular identification were performed. Positive rates were analyzed by Chi-square test. Results: In 2013-2016, the positive rates of JEV, EV, MuV and HSV were 9.0% (322/3 577 cases), 22.1% (643/2 916 cases), 9.9% (289/2 916 cases), 26.9% (783/2 916), respectively. Of these, the positive rates of JEV were 32.9% (261/794), 1.2% (14/1 175), 1.0% (8/807) and 4.9% (39/801 cases); EV: 19.5% (91/466), 35.1% (342/974 cases), 15.5% (115/743) and 13.0% (95/733); MuV: 9.2% (43/466), 14.4% (140/974), 9.0% (67/743) and 5.3% (39/733). HSV: 35.4% (165/466), 38.5% (375/974), 25.7% (191/743) and 7.1% (52/733). There were significant differences in positive rates of 4 kinds of viruses in 2013-2016 (P<0.001). A total of 81 EV strains belonging to 8 serotypes were isolated from 1 020 CSF specimens. The positive rates were 4.8% (6 cases), 13.1% (55 cases), 4.1% (7 cases) and 4.2% (13 cases) from 2013 to 2016. Coxsackievirus (CV) B5, echovirus (E) 6 and E30 accounted for 46% (37 isolates), 22% (18 isolates) and 21% (17 isolates) of all strains. Conclusion: The AMES cases in Jinan city in 2013-2016 were mainly caused by HSV, EV, MuV, JEV. CVB5, E6 and E30 were the dominant serotypes of EV associated with AMES cases in Jinan city.


Assuntos
Encefalite/etiologia , Meningite/etiologia , Vigilância de Evento Sentinela , China/epidemiologia , Cidades , Vírus da Encefalite Japonesa (Espécie)/isolamento & purificação , Enterovirus/isolamento & purificação , Humanos
19.
J Neuroimmunol ; 328: 73-75, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30597393

RESUMO

Rheumatoid meningitis is a rare and very serious extra-articular manifestation of rheumatoid arthritis. We present a case of a 7()year-old female with no history of arthritis who developed stroke-like symptoms, seizures, psychosis and compulsive behavior. Serial brain magnetic resonance images (MRI) over four months demonstrated progressive interhemispheric meningeal thickening. She had mild lymphocytic pleocytosis on the cerebrospinal fluid analysis and serum anti-cyclic citrullinated peptide antibodies resulted positive in high titers. She underwent a brain biopsy showing necrotizing granulomas consistent with rheumatoid meningitis. Her symptoms resolved with treatment with glucocorticoids and cyclophosphamide. She has not been diagnosed with rheumatoid arthritis even after 1 year of follow up. Clinicians should be aware of the possibility of rheumatoid meningitis without rheumatoid arthritis and keep it on the differential for patients with aseptic meningitis and otherwise negative work up.


Assuntos
Artrite Reumatoide/complicações , Meningite/etiologia , Idoso , Autoanticorpos/sangue , Autoanticorpos/imunologia , Feminino , Humanos , Meningite/diagnóstico , Peptídeos Cíclicos/sangue , Peptídeos Cíclicos/imunologia
20.
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
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