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Taylor MG, Ankar A, Meoded A, Jarjour IT, Risen S, McNeil JC. Eosinophilic Meningitis: Eleven-Year Experience at Texas Children's Hospital. J Pediatr 2022; 251:202-208.e1. [PMID: 35977618 DOI: 10.1016/j.jpeds.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/30/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022]
Abstract
Eosinophilic meningitis can be caused by various etiologies and is reported mostly in tropical climates. The diagnosis is rare in the continental US, presenting challenges for management. Following a case of pediatric eosinophilic meningitis, we reviewed our 11-year experience with this diagnosis at a large US children's hospital.
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Affiliation(s)
- Margaret G Taylor
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Alexander Ankar
- Division of Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Avner Meoded
- Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Imad T Jarjour
- Division of Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sarah Risen
- Division of Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - J Chase McNeil
- Division of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
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Babu I, Howard-Jones AR, Goetti R, Menezes MP, Arbuckle S, Britton PN. Paediatric neurocysticercosis in high income countries. Eur J Paediatr Neurol 2022; 39:88-95. [PMID: 35724517 DOI: 10.1016/j.ejpn.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Neurocysticercosis (NCC) is an unusual cause of seizures in high income settings. It typically presents as an afebrile seizure in a previously well child and can occur years after migration or travel. METHODS Children diagnosed with neurocysticercosis from 01 July 2005 to 30 June 2020 were identified from the electronic medical records of a tertiary children's hospital in Australia. Additionally, a 10-year compilation of case reports of paediatric NCC in high income settings was performed by medline search (publication years 2011-2021). Diagnosis and treatment of neurocysticercosis were reviewed with reference to diagnostic criteria of Del Brutto et al., and the 2017 Infectious Diseases Society of America treatment guidelines. RESULTS Over a fifteen-year period, eight children were diagnosed with NCC at our hospital in Sydney, Australia. Seizures and history of travel to or migration from South Asia were the two most frequently occurring findings. Children diagnosed after 2016 all received antiparasitic therapy. Outcomes were generally favorable, though long-term epilepsy resulted in some cases. Compiled case reports from high income settings revealed migration and travel exposures commensurate with local demographic patterns, and treatment approaches conforming with 2017 Infectious Diseases Society of America guidelines. CONCLUSIONS Clinicians should be aware of NCC as a differential diagnosis in children from endemic areas presenting with unprovoked seizures as misdiagnosis can occur. Expert review of neuroimaging facilitates diagnosis and can avert unnecessary neurosurgery. In Australia, India was a key exposure country for NCC, reflecting its endemic burden of disease and local travel and migration patterns.
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Affiliation(s)
- Indhumathi Babu
- Department of General Medicine, The Children's Hospital at Westmead, New South Wales, Australia.
| | - Annaleise R Howard-Jones
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Robert Goetti
- Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Medical Imaging, The Children's Hospital at Westmead, New South Wales, Australia
| | - Manoj P Menezes
- Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, New South Wales, Australia
| | - Susan Arbuckle
- Department of Histopathology, The Children's Hospital at Westmead, New South Wales, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Sydney Medical School, University of Sydney, New South Wales, Australia
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Jiang H, Xing Z, Liu X, Chai Q, Xin Z, Zhu C, Lin R, Deng X, Cui D, Gao H, Ma D. Comparison and development of a metagenomic next-generation sequencing protocol for combined detection of DNA and RNA pathogens in cerebrospinal fluid. BMC Infect Dis 2022; 22:326. [PMID: 35365081 PMCID: PMC8976360 DOI: 10.1186/s12879-022-07272-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate different pretreatment, extraction, amplification, and library generation methods for metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and to develop an efficient procedure for the simultaneous detection of DNA and RNA pathogens. METHODS We generated thirteen mock CSF samples with four representative pathogens of encephalitis. Each sample was subjected to ten different methods by varying sample pretreatment/nucleic acid extraction (microbial DNA, total DNA, total NA, total RNA, Whole Transcriptome Amplification (WTA)) and library generation (Illumina or NEB). Negative extraction controls (NECs) were used for each method variation. RESULTS We found that the quality of mNGS sequencing reads was higher from the NEB kit for library generation. Microbial DNA and total RNA increased microbial deposition by depleting the host DNA. Methods total NA and total RNA can detect gram-positive, gram-negative, RNA and DNA pathogens. We applied mNGS, including total NA and NEB library generation, to CSF samples from five patients diagnosed with infectious encephalitis and correctly determined all pathogens identified in clinical etiological tests. CONCLUSIONS Our findings suggested that total nucleic acid extraction combined with NEB library generation is the most effective mNGS procedure in CSF pathogen detection. The optimization of positive criteria and databases can improve the specificity and sensitivity of mNGS diagnosis. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800015425 (29/03/2018), https://www.chictr.org.cn/edit.aspx?pid=26292&htm=4 .
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Affiliation(s)
- Hanfang Jiang
- Institute of Pediatrics, Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zhihao Xing
- Institute of Pediatrics, Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiaorong Liu
- Institute of Pediatrics, Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Qiang Chai
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zefeng Xin
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Chunqing Zhu
- Institute of Pediatrics, Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Ruihong Lin
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xuwen Deng
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Dong Cui
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - HongDan Gao
- Medical Technology, Bengbu Medical College, Bengbu, Anhui, People's Republic of China
| | - Dongli Ma
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China.
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Graff K, Dominguez SR, Messacar K. Metagenomic Next-Generation Sequencing for Diagnosis of Pediatric Meningitis and Encephalitis: A Review. J Pediatric Infect Dis Soc 2021; 10:S78-S87. [PMID: 34951470 PMCID: PMC8703254 DOI: 10.1093/jpids/piab067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metagenomic next-generation sequencing is a novel diagnostic test with the potential to revolutionize the diagnosis of pediatric meningitis and encephalitis through unbiased detection of bacteria, viruses, parasites, and fungi in cerebrospinal fluid. Current literature is mostly observational with variable indications, populations, and timing of testing with resulting variability in diagnostic yield and clinical impact. Diagnostic stewardship strategies are needed to direct testing toward high-impact pediatric populations, to optimize timing of testing, to ensure appropriate interpretation of results, and to guide prompt optimization of antimicrobials. This review highlights the high clinical potential of this test, though future studies are needed to gather clinical impact and cost-effectiveness data for specific indications in pediatric populations.
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Affiliation(s)
- Kelly Graff
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA,Corresponding Author: Kelly E. Graff, MD, Pediatric Infectious Diseases, Children’s Hospital Colorado, B055, 13123 E 16th Ave, Aurora, CO 80045, USA. E-mail:
| | - Samuel R Dominguez
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA,Department of Pathology and Laboratory Medicine, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Kevin Messacar
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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