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Wei W, Qiao Z, Qin D, Lan Y. Acute multiple brain infarctions associated with Streptococcus suis infection: a case report. BMC Infect Dis 2024; 24:447. [PMID: 38671388 PMCID: PMC11046750 DOI: 10.1186/s12879-024-09318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Streptococcus suis is one of the most common zoonotic pathogens, in humans and can cause meningitis, endocarditis, arthritis and sepsis. Human cases of Streptococcus suis infection have been reported worldwide, and most of those cases occurred in Asia. Hearing loss is the most common sequela of Streptococcus suis meningitis. Streptococcus suis infection complicated with acute cerebral infarction has rarely been reported. Therefore, to provide a reference for this disease, we reported a case of acute multiple brain infarctions associated with Streptococcus suis infection. In our report, a 69yearold male patient had Streptococcus suis meningitis and sepsis, which were associated with multiple acute cerebral infarctions in the pons and bilateral frontotemporal parietal occipital lobes. After treatment, the patient exhibited cognitive impairment, dyspraxia and irritability. There are limited case reports of cerebral infarction associated with Streptococcus suis infection, and further research is needed to determine the best treatment method.
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Affiliation(s)
- Wenxin Wei
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Zhenhu Qiao
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Donghua Qin
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China
| | - Yu Lan
- Department of Neurology, Minzu Hospital Affiliated of Guangxi Medical University, Nanning, Guangxi, 530001, China.
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Rashid M, Das SN, Hasan MM, Hera MFH, Rana MM, Saha R. Frequency of Hyponatremia in Adults with Acute Bacterial Meningitis. Mymensingh Med J 2024; 33:360-364. [PMID: 38557511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Bacterial meningitis is a life-threatening disease. Bacterial meningitis patients are prone to develop acute hyponatremia. In the central nervous system infection hyponatremia could be due to the Syndrome of Inappropriate Anti Diuretic Hormone secretion. The frequency of hyponatremia in adults with acute bacterial meningitis patients was seen in this study. This cross-sectional study was conducted in the Internal Medicine Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh from February 2016 to July 2016. A total of 50 patients were enrolled in this study by purposive sampling. Among 50 acute bacterial meningitis patients, 33 (66%) were diagnosed as hyponatremic state. The mean serum sodium level of 33 hyponatremic bacterial meningitis cases was 130.66±2.95 mmol/L. Most of the cases (78.79%) were mild hyponatremic state (130 mmol/L-135 mmol/L) whereas 18.18% were revealed as moderate hyponatremia (125 mmol/L-129 mmol/L). Only 3.03% of cases were presented as severe cases (≤124 mmol/L). The result revealed that a large number of patients with acute bacterial meningitis were suffering from hyponatremia and in the majority of cases were mildly hyponatremic.
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Affiliation(s)
- M Rashid
- Dr Mamunoor Rashid, Indoor Medical Officer, Department of Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Hirose K, Li SZ, Gill R, Hartsock J. Pneumococcal Meningitis Induces Hearing Loss and Cochlear Ossification Modulated by Chemokine Receptors CX3CR1 and CCR2. J Assoc Res Otolaryngol 2024; 25:179-199. [PMID: 38472515 PMCID: PMC11018586 DOI: 10.1007/s10162-024-00935-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/12/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Pneumococcal meningitis is a major cause of hearing loss and permanent neurological impairment despite widely available antimicrobial therapies to control infection. Methods to improve hearing outcomes for those who survive bacterial meningitis remains elusive. We used a mouse model of pneumococcal meningitis to evaluate the impact of mononuclear phagocytes on hearing outcomes and cochlear ossification by altering the expression of CX3CR1 and CCR2 in these infected mice. METHODS We induced pneumococcal meningitis in approximately 500 C57Bl6 adult mice using live Streptococcus pneumoniae (serotype 3, 1 × 105 colony forming units (cfu) in 10 µl) injected directly into the cisterna magna of anesthetized mice and treated these mice with ceftriaxone daily until recovered. We evaluated hearing thresholds over time, characterized the cochlear inflammatory response, and quantified the amount of new bone formation during meningitis recovery. We used microcomputed tomography (microCT) scans to quantify cochlear volume loss caused by neo-ossification. We also performed perilymph sampling in live mice to assess the integrity of the blood-perilymph barrier during various time intervals after meningitis. We then evaluated the effect of CX3CR1 or CCR2 deletion in meningitis symptoms, hearing loss, macrophage/monocyte recruitment, neo-ossification, and blood labyrinth barrier function. RESULTS Sixty percent of mice with pneumococcal meningitis developed hearing loss. Cochlear fibrosis could be detected within 4 days of infection, and neo-ossification by 14 days. Loss of spiral ganglion neurons was common, and inner ear anatomy was distorted by scarring caused by new soft tissue and bone deposited within the scalae. The blood-perilymph barrier was disrupted at 3 days post infection (DPI) and was restored by seven DPI. Both CCR2 and CX3CR1 monocytes and macrophages were present in the cochlea in large numbers after infection. Neither chemokine receptor was necessary for the induction of hearing loss, cochlear fibrosis, ossification, or disruption of the blood-perilymph barrier. CCR2 knockout (KO) mice suffered the most severe hearing loss. CX3CR1 KO mice demonstrated an intermediate phenotype with greater susceptibility to hearing loss compared to control mice. Elimination of CX3CR1 mononuclear phagocytes during the first 2 weeks after meningitis in CX3CR1-DTR transgenic mice did not protect mice from any of the systemic or hearing sequelae of pneumococcal meningitis. CONCLUSIONS Pneumococcal meningitis can have devastating effects on cochlear structure and function, although not all mice experienced hearing loss or cochlear damage. Meningitis can result in rapid progression of hearing loss with fibrosis starting at four DPI and ossification within 2 weeks of infection detectable by light microscopy. The inflammatory response to bacterial meningitis is robust and can affect all three scalae. Our results suggest that CCR2 may assist in controlling infection and maintaining cochlear patency, as CCR2 knockout mice experienced more severe disease, more rapid hearing loss, and more advanced cochlear ossification after pneumococcal meningitis. CX3CR1 also may play an important role in the maintenance of cochlear patency.
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Affiliation(s)
- Keiko Hirose
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO, 63110, USA.
| | - Song Zhe Li
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO, 63110, USA
| | - Ruth Gill
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO, 63110, USA
- Department of Obstetric and Gynecology, Washington University, St. Louis, MO, USA
| | - Jared Hartsock
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO, 63110, USA
- Turner Scientific, Jacksonville, IL, USA
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Mark DG, Horton BH, Reed ME. Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. JAMA Netw Open 2024; 7:e247373. [PMID: 38639937 PMCID: PMC11031686 DOI: 10.1001/jamanetworkopen.2024.7373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/20/2024] Open
Abstract
Importance Subarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied. Objective To determine whether CT cerebral angiography use has increased in lieu of lumbar puncture among emergency department (ED) patients with headache, with an increase in unruptured intracranial aneurysm detection. Design, Setting, and Participants This retrospective cohort study took place in 21 community EDs of an integrated health care system in Northern California between 2015 and 2021. Participants were adult (aged >17 years) health plan members with a chief concern of headache. Exclusions were prior diagnoses of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral arteriovenous malformation, or cerebrospinal fluid shunt. Data were analyzed from October to November 2023. Exposures CT cerebral angiography and/or lumbar puncture during the ED encounter. Main Outcomes and Measures Primary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis. Results Among 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White. Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (-11.1%; 95% CI, -12.0% to -10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%). Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = -.34, respectively). Conclusions and Relevance In this cohort study of ED patients with headache, increases in CT cerebral angiography use were associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. While this shift in diagnostic strategy appeared safe in the short-term, the long-term consequences remain unclear.
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Affiliation(s)
- Dustin G. Mark
- Department of Emergency Medicine, Kaiser Permanente Medical Center, Oakland, California
- Department of Critical Care Medicine, Kaiser Permanente Medical Center, Oakland, California
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Brandon H. Horton
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Mary E. Reed
- Division of Research, Kaiser Permanente Northern California, Oakland
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Pelkonen T, Roine I, Cruzeiro ML, Kallio M, Peltola H. Pneumonia in childhood bacterial meningitis-Experience from three continents. Trop Med Int Health 2024; 29:319-326. [PMID: 38343008 DOI: 10.1111/tmi.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Although concomitant pneumonia is sometimes diagnosed in childhood bacterial meningitis, its role in the illness course and prognosis is not known. We examined these associations using prospectively collected data from Finland, Latin America and Angola. METHODS This was a secondary descriptive analysis of prospectively collected data (clinical and laboratory findings at admission, during hospitalisation and outcome) from five clinical bacterial meningitis trials. We included children aged 2 months to 15 years from sites with confirmed bacterial meningitis and potential concomitant pneumonia (diagnosed clinically with or without a chest radiograph). RESULTS Pneumonia was not observed in the 341 children included in Finland. Pneumonia was observed in 8% (51/606) of children in Latin America and in 46% (377/819) in Angola (p < 0.0001). In multivariate analyses, predisposing factors for pneumonia in Latin America were age <1 year, seizures and severe anaemia; the corresponding factors for Angola were preadmission duration of illness >3 days and non-meningococcal meningitis. Concomitant pneumonia increased the severity of the disease and disabling sequelae. CONCLUSION Bacterial meningitis with pneumonia is a major, previously undescribed entity of severe bacterial meningitis, especially in Angola.
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Affiliation(s)
- Tuula Pelkonen
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland
- Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Markku Kallio
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heikki Peltola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Hemmi H, Mori Y, Kuroda T, Kakinuma Y, Kokudai Y, Kato Y, Kubota S, Kawamura M, Murakami H. [A Case of Bacterial Meningitis in Which Occurrence of Ataxie Optique Led to Detection of a Small Subdural Abscess and Pialitis]. Brain Nerve 2024; 76:289-294. [PMID: 38514110 DOI: 10.11477/mf.1416202599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
We report the case of a 69-year-old man with bacterial meningitis who presented with ataxie optique in the peripheral part of the left visual field in both hands. A detailed neurological examination with contrast-enhanced brain MRI in the early stage of the clinical course identified a small subdural abscess and pialitis in the right parietal area. A favorable outcome was obtained with antibiotic therapy alone. In a case with higher brain dysfunction of unknown cause in the clinical course of bacterial meningitis, a detailed neurological examination may be helpful to identify the causative site. (Received September 25, 2023; Accepted October 31, 2023; Published March 1, 2024).
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Affiliation(s)
- Hikaru Hemmi
- Department of Neurology, Showa University School of Medicine
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Eberhard R, Paquette K, Garfinkle J, Myers KA. Response to Hydrocortisone in an Extremely Preterm Neonate With Late-Onset Sepsis, Meningoencephalitis, and Drug-Resistant Seizures. Clin EEG Neurosci 2024; 55:252-256. [PMID: 36567490 DOI: 10.1177/15500594221147138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Corticosteroids are commonly used in children with bacterial meningitis; however, there are very few data regarding possible utility in neonates, particularly those born premature. We describe our experience using hydrocortisone in the treatment of a girl born at 26 weeks, 6 days gestation. She had suffered profound brain injury following late onset group B streptococcus sepsis and meningitis, and developed drug-resistant seizures. Because seizures continued despite treatment with phenobarbital, phenytoin, levetiracetam, lacosamide, and midazolam, intravenous hydrocortisone was added. We observed a marked decrease in focal electrographic seizures within 2 days of initiation of hydrocortisone. This experience suggests that corticosteroids could be a treatment option for drug-resistant seizures and status epilepticus in preterm neonates, particularly those with bacterial meningitis.
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Affiliation(s)
- Ralf Eberhard
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Katryn Paquette
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jarred Garfinkle
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kenneth A Myers
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Child Health and Human Development Program, Research Institute of the McGill University Medical Centre, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Yanagida M, Hosoi Y, Kawano T, Otake Y, Yamanaka Y, Baba T, Ito M. Noniatrogenic Meningitis Caused by Streptococcus salivarius Associated with Early Esophageal Cancer and Early Gastric Cancer. Intern Med 2024; 63:457-460. [PMID: 37344440 PMCID: PMC10901718 DOI: 10.2169/internalmedicine.1304-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/14/2023] [Indexed: 06/23/2023] Open
Abstract
Streptococcus salivarius is part of the normal oral cavity and gastrointestinal tract microflora and an unusual cause of acute bacterial meningitis. We herein report an 81-year-old man with S. salivarius meningitis, which led to a diagnosis of early esophageal cancer and early gastric cancer. S. salivarius infection may occur through the gastrointestinal mucosa when it is disrupted in association with early gastrointestinal cancer. To our knowledge, this is the first report describing S. salivarius meningitis associated with multiple early gastrointestinal cancers in the absence of other sources of infection.
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Affiliation(s)
| | - Yasushi Hosoi
- Department of Neurology, Hamamatsu Medical Center, Japan
| | | | - Yusuke Otake
- Department of Neurology, Hamamatsu Medical Center, Japan
| | | | - Takeshi Baba
- Department of Pathology, Hamamatsu Medical Center, Japan
| | - Michiko Ito
- Department of Neurology, Hamamatsu Medical Center, Japan
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Krez A, Malinzak M, Feeney C. Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis. BMJ Case Rep 2024; 17:e256194. [PMID: 38238161 PMCID: PMC10806969 DOI: 10.1136/bcr-2023-256194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
A man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The patient was diagnosed with bacteremia and meningitis due to Streptococcus pneumoniae A standard antibiotic and corticosteroid regimen was started. Brain MRI showed an encephalocele abutting the superolateral nasopharynx mucosa. After several days of clinical improvement, the patient's mental status and headache acutely relapsed. A CT head venogram showed a large volume pneumocephalus originating from the region of a surgical defect. Management included external ventricular drain placement followed by right pterional craniotomy with skull base packing. Skull base defects increase the risk of life-threatening conditions such as bacterial meningitis and pneumocephalus. It is crucial for clinicians to be aware of the possibility of cranial surgical defects developing years after surgery.
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Affiliation(s)
- Alexandra Krez
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Malinzak
- Department of Radiology, Duke University Hospital, Durham, North Carolina, USA
| | - Colby Feeney
- Departments of Medicine and Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Palasamudram Kumaran S, Mathew T, John SK, Goddu Govindappa SK. Spinal cord infarction: a rare but serious complication of pneumococcal meningoencephalitis. BMJ Case Rep 2024; 17:e252209. [PMID: 38171643 PMCID: PMC10773378 DOI: 10.1136/bcr-2022-252209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Here, we report the case of a woman in her 40s who came with pyogenic meningitis and infarcts in the brain. While on treatment with antibiotics, she developed new-onset weakness involving bilateral lower limbs and one upper limb 2 weeks into the course of illness. MRI of the spine showed an infarct in the spinal cord. Spinal cord infarction as a complication of pyogenic meningitis is not well recognised unlike tuberculosis meningitis. Unlike ischaemic strokes where thrombolysis is done, for stroke related to infections, there are no definite strategies. Our patient was treated with physiotherapy, continued on antibiotics and slowly recovered over months and at 18-month follow-up, she was walking with a walker. The exact mechanism of thrombosis is not known but may be due to inflammation of the arterial wall and activation of the procoagulant cascade by infection-triggered inflammation. Spinal cord infarction can occur at any phase of the infection and may occur despite appropriate response to antibiotic treatments.
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Affiliation(s)
| | - Thomas Mathew
- Department of Neurology, St John's Medical College, Bangalore, Karnataka, India
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Mohanty S, Johansson Kostenniemi U, Silfverdal SA, Salomonsson S, Iovino F, Sarpong EM, Bencina G, Bruze G. Increased Risk of Long-Term Disabilities Following Childhood Bacterial Meningitis in Sweden. JAMA Netw Open 2024; 7:e2352402. [PMID: 38241045 PMCID: PMC10799263 DOI: 10.1001/jamanetworkopen.2023.52402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Importance Few studies have examined the incidence of long-term disabilities due to bacterial meningitis in childhood with extended follow-up time and a nationwide cohort. Objective To describe the long-term risks of disabilities following a childhood diagnosis of bacterial meningitis in Sweden. Design, Setting, and Participants This nationwide retrospective registry-based cohort study included individuals diagnosed with bacterial meningitis (younger than 18 years) and general population controls matched (1:9) by age, sex, and place of residence. Data were retrieved from the Swedish National Patient Register from January 1, 1987, to December 31, 2021. Data were analyzed from July 13, 2022, to November 30, 2023. Exposure A diagnosis of bacterial meningitis in childhood recorded in the National Patient Register between 1987 and 2021. Main Outcomes and Measures Cumulative incidence of 7 disabilities (cognitive disabilities, seizures, hearing loss, motor function disorders, visual disturbances, behavioral and emotional disorders, and intracranial structural injuries) after bacterial meningitis in childhood. Results The cohort included 3623 individuals diagnosed with bacterial meningitis during childhood and 32 607 controls from the general population (median age at diagnosis, 1.5 [IQR, 0.4-6.2] years; 44.2% female and 55.8% male, median follow-up time, 23.7 [IQR, 12.2-30.4] years). Individuals diagnosed with bacterial meningitis had higher cumulative incidence of all 7 disabilities, and 1052 (29.0%) had at least 1 disability. The highest absolute risk of disabilities was found for behavioral and emotional disorders, hearing loss, and visual disturbances. The estimated adjusted hazard ratios (HRs) showed a significant increased relative risk for cases compared with controls for all 7 disabilities, with the largest adjusted HRs for intracranial structural injuries (26.04 [95% CI, 15.50-43.74]), hearing loss (7.90 [95% CI, 6.68-9.33]), and motor function disorders (4.65 [95% CI, 3.72-5.80]). The adjusted HRs for cognitive disabilities, seizures, hearing loss, and motor function disorders were significantly higher for Streptococcus pneumoniae infection (eg, 7.89 [95% CI, 5.18-12.02] for seizure) compared with Haemophilus influenzae infection (2.46 [95% CI, 1.63-3.70]) or Neisseria meningitidis infection (1.38 [95% CI, 0.65-2.93]). The adjusted HRs for cognitive disabilities, seizures, behavioral and emotional disorders, and intracranial structural injuries were significantly higher for children diagnosed with bacterial meningitis at an age below the median. Conclusions and Relevance The findings of this cohort study of individuals diagnosed with bacterial meningitis during childhood suggest that exposed individuals may have had an increased risk for long-term disabilities (particularly when diagnosed with pneumococcal meningitis or when diagnosed at a young age), highlighting the need to detect disabilities among surviving children.
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Affiliation(s)
- Salini Mohanty
- Center for Observational and Real-World Evidence (CORE), Merck & Co Inc, Rahway, New Jersey
| | | | | | | | - Federico Iovino
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eric M. Sarpong
- Real-World Data Analytics and Innovation, Merck & Co Inc, Rahway, New Jersey
| | | | - Gustaf Bruze
- Division of Clinical Epidemiology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Batino LKJ, Cinco MTT, Navarro JC, Badillo SPJ, Qureshi AI, Sharma VK. Transcranial Doppler ultrasonography in bacterial meningitis: A systematic review. J Clin Ultrasound 2024; 52:78-85. [PMID: 37915120 DOI: 10.1002/jcu.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Bacterial meningitis remains a global threat due to its high mortality. It is estimated that >1.2 million cases of bacterial meningitis are reported annually. Intracranial vasculopathy is an important, under-documented complication, easily detected by transcranial Doppler (TCD) ultrasonography. Following the PRISMA Guidelines, we reviewed the utility of TCD in bacterial meningitis. METHODS This is a systematic review of observational studies on the use of TCD in patients with CSF-proven bacterial meningitis. Characteristic changes in TCD parameters along the course of the disease, correlation of TCD findings with neuroimaging, and functional outcomes were evaluated. RESULTS Nine studies were included with a total of 492 participants (mean age of 42). The most common TCD finding was intracranial arterial stenosis of the MCA (50%-82%) and ischemia (33%) was the predominant neuroimaging finding. The presence of an abnormal TCD finding increased the risk of poor outcomes as high as 70%. CONCLUSIONS Patients diagnosed with bacterial meningitis who underwent TCD show alterations in cerebral blood flow, correlating with imaging findings and poor outcomes. It aids in the diagnosis of its sequelae and can predict the prognosis of its outcome. TCD is a cost-effective, reliable modality for diagnosing vasculopathy associated with bacterial meningitis. It may prove useful in our armamentarium of management. Large prospective studies with long-term follow-up data may help establish the use of TCD in bacterial meningitis.
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Affiliation(s)
- Laurence Kristoffer J Batino
- Department of Neurology, Zeenat Qureshi Stroke Institute, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Mark Timothy T Cinco
- Department of Neurology, Zeenat Qureshi Stroke Institute, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Jose C Navarro
- Department of Neurology, Zeenat Qureshi Stroke Institute, Jose R. Reyes Memorial Medical Center, Manila, Philippines
- Department of Neuroscience and Behavioral Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Stephanie Patricia J Badillo
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, Missouri, USA
| | - Vijay K Sharma
- YLL School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore, Singapore
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Sudo RYU, Câmara MCC, Kieling SV, Marques IR, Mesquita Y, Piepenbrink BE, Mari PC. Shorter versus longer duration of antibiotic treatment in children with bacterial meningitis: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:61-71. [PMID: 37870611 DOI: 10.1007/s00431-023-05275-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023]
Abstract
The optimal duration of antibiotic treatment for the most common bacterial meningitis etiologies in the pediatric population, namely Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, is not well-established in the literature. Therefore, we aimed to perform an updated meta-analysis comparing shorter versus longer antibiotic treatment in children with meningitis. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) that compared shorter (up to 7 days) versus longer (10 days or double the days of the equivalent short course) duration of antibiotic treatment in children with meningitis and reported the outcomes of treatment failure, death, neurologic sequelae, non-neurologic complications, hearing impairment, nosocomial infection, and relapse. Heterogeneity was examined with I2 statistics. RevMan 5.4.1 was used for statistical analysis and RoB-2 (Cochrane) for risk of bias assessment. Of 684 search results, 6 RCTs were included, with a cohort of 1333 children ages 3 weeks to 15.5 years, of whom 49.51% underwent a short antibiotic course. All RCTs included monotherapy with ceftriaxone, except one, which added vancomycin as well. No differences were found comparing the short and long duration of therapy concerning treatment failure, relapse, mortality, and neurologic complications at discharge and at follow-up. Conclusion: Because no statistically significant differences were found between groups for the analyzed outcomes, the results of this meta-analysis support shorter therapy. However, generalizing these results to complicated meningitis and infections caused by other pathogens should be made with caution. (PROSPERO identifier: CRD42022369843). What is Known: • Current recommendations on the duration of antibiotic therapy for bacterial meningitis are mostly based on clinical practice. • Defining an optimal duration of antibiotic therapy is essential for antimicrobial stewardship achievement, improving patient outcomes, and minimizing adverse effects. What is New: • There are no differences between shorter versus longer antibiotic treatment duration in regard to treatment failure, relapse, mortality, neurologic complications, and hearing impairment at discharge and at follow-up.
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Affiliation(s)
- Renan Yuji Ura Sudo
- Division of Medicine, Federal University of Grande Dourados, Dourados, MS, Brazil.
| | | | | | - Isabela Reis Marques
- Division of Medicine, Universitat Internacional de Catalunya, Barcelona, CAT, Spain
| | - Yasmin Mesquita
- Division of Medicine, Federal University of Rio de Janeiro, Macaé, RJ, Brazil
| | - Blake Earl Piepenbrink
- Division of Internal Medicine, Primary Care, University of Connecticut, Farmington, CT, USA
| | - Paula Chaves Mari
- Pediatric Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Van RN, Tubiana S, De Broucker T, Cédric J, Roy C, Meyohas MC, Prazuck T, Chirouze C, Hoen B, Duval X, Revest M. Persistent headaches one year after bacterial meningitis: prevalence, determinants and impact on quality of life. Eur J Clin Microbiol Infect Dis 2023; 42:1459-1467. [PMID: 37867184 DOI: 10.1007/s10096-023-04673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life. METHODS In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed. RESULTS Among the 277 alive patients at M12 87/274 (31.8%), 213/271 (78.6%) and 86/277 (31.0%) reported headaches before, at the onset, and at M12, respectively. In multivariate analysis, female sex (OR: 2.75 [1.54-4.90]; p < 0.001), pre-existing headaches before meningitis (OR: 2.38 [1.32-4.30]; p < 0.01), higher neutrophilic polynuclei percentage in the CSF of the initial lumbar puncture (OR: 1.02 [1.00-1.04]; p < 0.05), and brain abscess during the initial hospitalisation (OR: 8.32 [1.97-35.16]; p < 0.01) were associated with M12 persistent headaches. Neither the responsible microorganism, nor the corticoids use were associated with M12 persistent headaches. M12 neuro-functional disability (altered Glasgow Outcome Scale; p < 0.01), M12 physical handicap (altered modified Rankin score; p < 0.001), M12 depressive symptoms (p < 0.0001), and M12 altered physical (p < 0.05) and mental (p < 0.0001) qualities of life were associated with M12 headaches. CONCLUSION Persistent headaches are frequent one year after meningitis and are associated with quality of life alteration. CLINICAL TRIAL NCT01730690.
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Affiliation(s)
- Rémi Nguyen Van
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France
| | - Sarah Tubiana
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
| | | | | | - Carine Roy
- Epidemiology, Biostatistics and Clinical Research Unit, Bichat Claude Bernard Hospital, APHP, Paris, France
| | | | | | | | - Bruno Hoen
- Infectious Diseases Unit, CHU Nancy, France
| | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité, France
- Centre d'investigation Clinique, Hôpital Bichat, APHP, Inserm CIC 1425, Paris, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, UMR_1230, BRM (Bacterial RNA and Medicine), Inserm, CHU Rennes, Université Rennes 1, CIC-Inserm 1414, Rennes, France.
- UMR-1230 BRM (Bacterial RNA and Medicine), Inserm, Université Rennes, Rennes, France.
- Centre d'investigation Clinique, CHU Rennes, Inserm CIC 1414, Rennes, France.
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15
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Zhang Y, Zheng Y. Leptospirosis-associated meningitis in a patient with sjögren's syndrome: a case report. BMC Infect Dis 2023; 23:778. [PMID: 37946137 PMCID: PMC10636908 DOI: 10.1186/s12879-023-08794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. CASE PRESENTATION The patient had a definitive pathological diagnosis of Sjögren's syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. CONCLUSIONS The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases.
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Affiliation(s)
- Yifan Zhang
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Yong Zheng
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China.
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16
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Heide SK, Gnanaprakasam R, Bornovski Y, Feldstein E, Keller M, Rosenberg J. Clinical Reasoning: An Older Woman With Headaches and Lethargy After a Fall. Neurology 2023; 101:863-868. [PMID: 37604660 PMCID: PMC10662998 DOI: 10.1212/wnl.0000000000207828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
In this case, a 77-year-old woman presented with generalized weakness, difficulty ambulating, lethargy, loss of appetite, and headaches after a mechanical fall. This case discusses the management of acute neurologic emergencies such as subdural hematoma, status epilepticus, and bacterial meningitis. Potential etiologies for stroke and CNS infection are highlighted. Readers are led through the diagnostic approach to a patient presenting with a complex array of neurologic symptoms causing rapid clinical decompensation.
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Affiliation(s)
- Sara K Heide
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY.
| | - Rachel Gnanaprakasam
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY
| | - Yarden Bornovski
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY
| | - Eric Feldstein
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY
| | - Marina Keller
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY
| | - Jon Rosenberg
- From the Department of Neurology (S.K.H.), Mount Sinai Beth Israel Medical Center, New York; Department of Infectious Disease (R.G., M.K.), Department of Neurology (Y.B., J.R.), and Department of Neurosurgery (E.F.), Westchester Medical Center, Valhalla, NY
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17
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Büttner LC, Schroth M. [Pediatric infectious emergencies-from febrile seizure to purpura fulminans]. Med Klin Intensivmed Notfmed 2023; 118:646-655. [PMID: 37466696 DOI: 10.1007/s00063-023-01031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 07/20/2023]
Abstract
Febrile seizures, which are relatively common in young children, are often triggered by an infection and resolve quickly. Prompt presentation to a pediatric department is mandatory after any first seizure and every time for children ≤ 12 months. Central nervous system (CNS) diseases in childhood are able to cause seizures or other neurological disorders. Even the slightest suspicion of a seizure with CNS involvement must be promptly treated. In case of doubt, both an antiviral and an antibacterial treatment are started in parallel, which can be stopped after detecting the pathogen. Lumbar puncture is strictly indicated unless there are contraindications. Meningococcal sepsis is a severe clinical feature comprising high fever, chills and disorders of consciousness. The first skin symptoms are petechiae as a red flag sign. With progression, potentially lethal purpura fulminans may develop. Waterhouse-Friderichsen syndrome is a severe complication of acute bacterial meningitis. Lethality rate is 35%. The pediatric assessment triangle and the ABCDE algorithm help to identify critically ill children in a standardized, structured, and rapid manner.
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Affiliation(s)
| | - Michael Schroth
- Abteilung Pädiatrie und Neonatologie, Diakoneo Cnopfsche Kinderklinik, Nürnberg, Deutschland
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18
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Cohen K, Gregory G, Nolin J, Sappington A, Hardy J, Alexander J, Walker D, Giannini J. Bacterial Meningitis With Cerebral Edema in a Young Adult: A Simulation Case for Medical Students. MedEdPORTAL 2023; 19:11354. [PMID: 37900702 PMCID: PMC10603216 DOI: 10.15766/mep_2374-8265.11354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 06/20/2023] [Indexed: 10/31/2023]
Abstract
Introduction Simulation in the preclinical medical education setting is a beneficial tool for students to develop clinical skills, supplement preexisting knowledge, and prepare for clinical rotations and beyond. We detail the complete simulation scenario, including a participant postresponse questionnaire, of a 28-year-old male who developed bacterial meningitis after experiencing an upper respiratory infection in the days prior. Methods Simulation fellows and faculty at the Alabama College of Osteopathic Medicine created a simulation scenario pertaining to bacterial meningitis. The scenario utilized a high-fidelity patient simulator, one standardized participant for patient voiceover, one standardized participant as a patient family member, and one standardized participant as a physician consultant on an as-needed basis. Sixteen preclinical medical students from various specialty interest groups were recruited to participate in the scenario and complete the postscenario questionnaire. Results The simulation scenario was well received by the participants, and 15 of 16 completed the postscenario questionnaire. Ninety-three percent strongly agreed the simulation was a valuable clinical experience. Additionally, 73% of participants strongly agreed that the simulation experience was realistic, 80% strongly agreed that it tested their clinical reasoning ability, and 53% strongly agreed it was appropriate for their level of clinical knowledge. Discussion Medical simulation is a valuable educational tool tailored to maximize student learning and supplement the traditional didactic curriculum. The successful development and implementation of our meningitis simulation case further supports the continued use of medical simulation in the preclinical setting.
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Affiliation(s)
- Kyle Cohen
- Third-Year Medical Student and Simulation Fellow, Alabama College of Osteopathic Medicine
| | - Grant Gregory
- Third-Year Medical Student and Simulation Fellow, Alabama College of Osteopathic Medicine
| | - James Nolin
- Instructor of Primary Clinical Skills, Alabama College of Osteopathic Medicine
| | - Alexandra Sappington
- Third-Year Medical Student and Simulation Fellow, Alabama College of Osteopathic Medicine
| | - Jonathan Hardy
- Third-Year Medical Student and Simulation Fellow, Alabama College of Osteopathic Medicine
| | - Julia Alexander
- Assistant Professor of Radiology, Alabama College of Osteopathic Medicine
| | - Dianne Walker
- Simulation Curriculum Coordinator, Alabama College of Osteopathic Medicine
| | - John Giannini
- Associate Professor of Internal Medicine and Director of Simulation, Alabama College of Osteopathic Medicine
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19
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Shome A, Da Silva PP, Wenger PN, Kumta JN. Neonatal Salmonella Meningitis With Subdural Empyema: A Case Report. Pediatr Infect Dis J 2023; 42:e390-e392. [PMID: 37310891 DOI: 10.1097/inf.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ashna Shome
- Department of Pediatrics Jacobi Medical Center New York, NY
| | - Poliana P Da Silva
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
| | - Peter N Wenger
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
| | - Jayshree N Kumta
- Department of Pediatrics, Children Hospital of New Jersey at Newark Beth Israel, RWJ Barnabas Health, Newark, New Jersey
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20
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Pelkonen T, Kallio M, Latvala T, Roine I, Peltola H. Clinical blindness in conjunction with childhood bacterial meningitis. Sci Rep 2023; 13:15530. [PMID: 37726355 PMCID: PMC10509259 DOI: 10.1038/s41598-023-41685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
Although rarely reported, bilateral loss of vision is a severe complication of childhood bacterial meningitis. We assessed its frequency in five prospective treatment trials performed in Europe, Latin America, and Angola in 1984-2017. Course of illness, follow-up findings, and child's sight were recorded. Sight was examined at discharge, and conditions permitting, also at 1-3 months post-hospitalization and in Angola on hospital day 7. Experienced pediatricians diagnosed clinical blindness if the child did not make eye contact, did not blink or move the eyes, or remained unresponsive to bright light or movement of large objects before their eyes. Of 1515 patients, 351, 654, and 510 were from Finland, Latin America, and Angola, respectively. At discharge, blindness was observed in 0 (0%), 8 (1.2%), and 51 (10%) children, respectively. In Angola, 64 children appeared to be blind on day 7; 16 of these children died. Blindness found at discharge in Angola was not invariably irreversible; approximately 40% had restored the sight at follow-up visit. Clinical blindness rarely occurred in isolation and was usually associated with young age and poor general condition at hospital arrival. Various other serious sequelae were common among the survivors with clinical blindness.
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Affiliation(s)
- Tuula Pelkonen
- Pediatrics, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00029, Helsinki, Finland.
- New Children's Hospital, Pediatric Research Center, P.O. Box 347, 00029 HUS, Helsinki, Finland.
- Hospital Pediátrico David Bernardino, Luanda, Angola.
| | - Markku Kallio
- Pediatrics, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00029, Helsinki, Finland
| | - Terho Latvala
- Ophthalmology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | - Heikki Peltola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, 00029, Helsinki, Finland.
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21
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He L, Li H, Zhang Z, Ge H, Wang H, Zhu M, Xu Z, Zhang J, Fang S, Hu C, Qian L, Xu H, Yao Y, Yuan S, Zhu J, Lu C, Zheng J, Li J, Jiang Q, Xu H, Chen L, Shang S, Chen Y. Factors associated with afebrile presentation and delayed defervescence of bacterial meningitis in children under 3 years of age: a multi-centre retrospective analysis. BMC Pediatr 2023; 23:470. [PMID: 37723538 PMCID: PMC10507889 DOI: 10.1186/s12887-023-04179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/05/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND This multi-center study aimed to identify factors affecting fever and delayed defervescence in bacterial meningitis (BM) patients under 3 years of age because of the variability of fever in this patient population. METHODS Only BM patients under 3 years treated at 49 centers in China from November 2018 to end-April 2021 were included in the study. Univariate and multivariate logistic regression analyses were performed to determine factors associated with afebrile presentation and fever of delayed defervescence. RESULTS A total of 863 BM patients under 3 years were included in the study. Coagulase negative staphylococcus was associated with afebrile presentation (OR = 1.176), while septicaemia and ear-nose-throat infections were associated with fever (P < 0.05). The patients with fever were assigned into early and delayed defervescence groups based on defervescence time (less than and more than or equal to one week). Furthermore, Streptococcus agalactiae meningitis (OR = 1.124), concomitant gastrointestinal infection (OR = 1.276), encephalomalacia (or = 1.339), and subdural effusion (OR = 1.454) were independently associated with delayed defervescence (all P < 0.05). CONCLUSIONS The findings can aid in the efficient utilization of fever in auxiliary diagnosis and evaluating the condition of the disease.
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Affiliation(s)
- Lin He
- Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Haijing Li
- Department of Pediatric, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Zhigang Zhang
- Department of Pediatric, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Hejia Ge
- Department of Pediatric, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hongwei Wang
- Department of Pediatric, Shaoxing Keqiao Women and Children's Hospital, Shaoxing, China
| | - Mengquan Zhu
- Department of Pediatric, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhiwei Xu
- Department of Pediatric, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiening Zhang
- Department of Pediatric, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Sheng Fang
- Department of Pediatric, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Chuanze Hu
- Department of Pediatric, Jinhua Maternal and Child Health Care Hospital, Jinhua, China
| | - Lijun Qian
- Department of Pediatric, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Huifang Xu
- Department of Pediatric, Lanxi People's Hospital, Lanxi, China
| | - Yinna Yao
- Department of Pediatric, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Shengfu Yuan
- Department of Pediatric, Yuyao People's Hospital, Yuyao, China
| | - Jiajun Zhu
- Division of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaosheng Lu
- Department of Pediatric, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jishan Zheng
- Department of Pediatric, Ningbo Women and Children Hospital, Ningbo, China
| | - Junsheng Li
- Department of Pediatric, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Qi Jiang
- Department of Pediatric, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Huiqing Xu
- Department of Pediatric, Ningbo Women and Children Hospital, Ningbo, China
| | - Lihua Chen
- Division of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China
| | - Shiqiang Shang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China.
| | - Yinghu Chen
- Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, China.
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22
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Takao K, Matsuta H, Murata K, Fujiki M. Reversible cerebral vasospasm and cerebral infarction secondary to meningitis following penetrating head trauma with bamboo. BMJ Case Rep 2023; 16:e254676. [PMID: 37553171 PMCID: PMC10414058 DOI: 10.1136/bcr-2023-254676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
A man in the 70s fell on a bamboo and punctured his left upper eyelid. CT of the head showed fractures of the medial and superior walls of the left orbit, intracranial traumatic subarachnoid haemorrhage, intraventricular haematoma and left frontal cerebral contusion. He was treated conservatively. Despite prophylactic antibiotic therapy, he had prolonged loss of consciousness. A cerebrospinal fluid examination revealed bacterial meningitis. Imaging studies on day 15 showed extensive subacute cerebral infarction in the bilateral parieto-occipital lobes and main trunk artery stenosis. On day 31, MRA showed improvement of the main arteries, and cerebral vasospasm-induced cerebral infarction was diagnosed. He was transferred to rehabilitation with full assistance. The prognosis of bamboo perforation trauma is critical. Thus, preventing and treating central nervous system infection are considered the key to the prognosis. However, given the lack of established treatment for meningitis-associated cerebral vasospasm, case-specific treatment must be considered.
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Affiliation(s)
- Kunpei Takao
- Department of Neurosurgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroyuki Matsuta
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Kumi Murata
- Department of Forensic Medicine, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
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23
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Vâţă A, Irimie-Băluţă E, Roşu FM, Onofrei IM, Loghin II, Perţea M, Avădanei AN, Miron M, Rădulescu L, Eşanu I, Luca CM. Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review. Medicina (Kaunas) 2023; 59:1428. [PMID: 37629718 PMCID: PMC10456347 DOI: 10.3390/medicina59081428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe-anaerobe meningitis.
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Affiliation(s)
- Andrei Vâţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Erika Irimie-Băluţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
| | - Florin Manuel Roşu
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
- Department of Dento-Alveolar Surgery, Anesthesia, Sedation, and Medical-Surgical Emergencies, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Maria Onofrei
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Isabela Ioana Loghin
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Mihaela Perţea
- Department of Surgery 1, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | | | - Mihnea Miron
- Intensive Care Department, “Sf. Spiridon” Emergency Hospital, 700115 Iasi, Romania;
| | - Luminiţa Rădulescu
- ENT Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Eşanu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cătălina Mihaela Luca
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.V.); (E.I.-B.); (I.M.O.); (C.M.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
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Saldanha M, Nayar V, Augustine BA, Shenoy RD. Acute Bacterial Meningitis and Petrous Apicitis in a Child with Aplasia Cutis Congenita: A Case Report. J Int Adv Otol 2023; 19:355-359. [PMID: 37528601 PMCID: PMC10544651 DOI: 10.5152/iao.2023.22888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/14/2023] [Indexed: 08/03/2023] Open
Abstract
Petrous apicitis and acute bacterial meningitis are uncommon in the present antibiotic era. The diagnosis of petrous apicitis is seldom considered unless there is cranial nerve palsy. A young child with aplasia cutis congenita presented with acute bacterial meningitis and an incidental opacified left mastoid in brain imaging. During the course, fever persisted, and high-resolution temporal bone imaging showed rapid progression to coalescent mastoiditis, petrous apicitis with erosions of tegmen tympani, and petrous apex. Other findings included bony dehiscences and thinning of left calvaria. Tympanomastoid exploration showed herniated brain and cerebrospinal fluid leak through tegmen tympani, which was closed with temporalis fascia graft. Herein, we report a rare presentation of petrous and tegmen erosion along with aplasia cutis congenita and discuss the challenges in diagnosis and management.
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Affiliation(s)
- Marina Saldanha
- Department of Otorhinolaryngology, KS Hegde Medical Academy, NITTE, Mangalore, India
| | - Vhaishakh Nayar
- Department of Otorhinolaryngology, KS Hegde Medical Academy, NITTE, Mangalore, India
| | | | - Rathika D. Shenoy
- Department of Paediatrics, KS Hegde Medical Academy, NITTE, Mangalore, India
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25
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Raffaele JL, Sharma M, Berger S, Mitchell M, Lee C, Morrison J, Prasad M, Combs MD, Molas-Torreblanca K, Wood JK, Van Meurs A, Westphal K, Sawani A, Banker SL, Lee J, King C, Halvorson EE, Potisek NM. Prevalence of Invasive Bacterial Infection in Hypothermic Young Infants: A Multisite Study. J Pediatr 2023; 258:113407. [PMID: 37023947 DOI: 10.1016/j.jpeds.2023.113407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To determine the prevalence of bacteremia and meningitis (invasive bacterial infection [IBI]) in hypothermic young infants, and also to determine the prevalence of serious bacterial infections (SBI) and neonatal herpes simplex virus and to identify characteristics associated with IBI. STUDY DESIGN We conducted a retrospective cohort study of infants ≤90 days of age who presented to 1 of 9 hospitals with historical or documented hypothermia (temperature ≤36.0°C) from September 1, 2017, to May 5, 2021. Infants were identified by billing codes or electronic medical record search of hypothermic temperatures. All charts were manually reviewed. Infants with hypothermia during birth hospitalization, and febrile infants were excluded. IBI was defined as positive blood culture and/or cerebrospinal fluid culture treated as a pathogenic organism, whereas SBI also included urinary tract infection. We used multivariable mixed-effects logistic regression to identify associations between exposure variables and IBI. RESULTS Overall, 1098 young infants met the inclusion criteria. IBI prevalence was 2.1% (95% CI, 1.3-2.9) (bacteremia 1.8%; bacterial meningitis 0.5%). SBI prevalence was 4.4% (95% CI, 3.2-5.6), and neonatal herpes simplex virus prevalence was 1.3% (95% CI, 0.6-1.9). Significant associations were found between IBI and repeated temperature instability (OR, 4.9; 95% CI, 1.3-18.1), white blood cell count abnormalities (OR, 4.8; 95% CI, 1.8-13.1), and thrombocytopenia (OR, 5.0; 95% CI, 1.4-17.0). CONCLUSIONS IBI prevalence in hypothermic young infants is 2.1%. Further understanding of characteristics associated with IBI can guide the development decision tools for management of hypothermic young infants.
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Affiliation(s)
- Jennifer L Raffaele
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, NC.
| | - Meenu Sharma
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, AL
| | - Stephanie Berger
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, AL
| | - Meredith Mitchell
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Clifton Lee
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - John Morrison
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madhuri Prasad
- Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Monica D Combs
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kira Molas-Torreblanca
- Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, CA
| | - Julie K Wood
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Annalise Van Meurs
- Department of Pediatrics, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR
| | - Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Ali Sawani
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Sumeet L Banker
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY
| | - Jennifer Lee
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY
| | - Coleton King
- Department of Psychology, Clemson University, Clemson, SC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Nicholas M Potisek
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, NC; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
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26
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Singla SK, Singh R. A Case of Acute Bacterial Meningitis Presenting with Cerebellar Infarct. Neurol India 2023; 71:777-778. [PMID: 37635517 DOI: 10.4103/0028-3886.383848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Sanjeev K Singla
- Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Rakendra Singh
- Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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Soti Khiabani M, Mohammadi MS, Ashrafi MR, Haider SB, Haider SI, Mahmoudi S, Mamishi S. Evaluation of patients presenting with febrile seizures in an Iranian referral hospital: emphasis on the frequency of meningitis and co-infections. BMC Pediatr 2023; 23:316. [PMID: 37349740 PMCID: PMC10288671 DOI: 10.1186/s12887-023-04120-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures. METHODS This retrospective cross-sectional study was conducted at the Children's Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients' data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated. RESULTS A total of 290 patients were referred to the Children's Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination. CONCLUSION Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.
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Affiliation(s)
- Mahsa Soti Khiabani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Sadat Mohammadi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Emergency Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
- Pediatric Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Shima Mahmoudi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Biotechnology Centre, Silesian University of Technology, Gliwice, 44-100, Poland.
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, , Children's Medical Center Hospital, Dr. Gharib Street, Keshavarz Boulevard, I.R, Tehran, Iran.
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Castagno E, Aguzzi S, Rossi L, Gallo R, Carpino A, Ricceri F, Urbino AF, Bondone C. Clinical Predictors and Biomarkers in Children With Sepsis and Bacterial Meningitis. Pediatr Emerg Care 2023; 39:311-317. [PMID: 36715265 DOI: 10.1097/pec.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Sepsis and meningitis in children may present with different clinical features and a wide range of values of inflammatory markers. The aim of this study was to identify the prognostic value of clinical features and biomarkers in children with sepsis and bacterial meningitis in the emergency department (ED). METHODS We carried out a single-center, retrospective, observational study on 194 children aged 0 to 14 years with sepsis and bacterial meningitis admitted to the pediatric ED of a tertiary children's hospital through 12 years. RESULTS Among epidemiological and early clinical features, age older than 12 months, capillary refill time greater than 3 seconds, and oxygen blood saturation lower than 90% were significantly associated with unfavorable outcomes, along with neurological signs ( P < 0.05). Among laboratory tests, only procalcitonin was an accurate and early prognostic biomarker for sepsis and bacterial meningitis in the ED, both on admission and after 24 hours. Procalcitonin cut-off value on admission for short-term complications was 19.6 ng/mL, whereas the cut-off values for long-term sequelae were 19.6 ng/mL on admission and 41.9 ng/mL after 24 hours, respectively. The cut-off values for mortality were 18.9 ng/mL on admission and 62.4 ng/mL at 24 hours. CONCLUSIONS Procalcitonin, along with clinical evaluation, can guide the identification of children at higher risk of morbidity and mortality, allowing the most appropriate monitoring and treatment.
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Affiliation(s)
- Emanuele Castagno
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Sonia Aguzzi
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorenza Rossi
- Division of Pediatrics and Neonatology, P.O. Ciriè, ASL-TO4, Ciriè (TO), Italy
| | - Rachele Gallo
- Pediatric Department, E. Agnelli Hospital, Pinerolo (TO), Italy
| | - Andrea Carpino
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy
| | - Antonio F Urbino
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- From the Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Pinho-Ribeiro FA, Deng L, Neel DV, Erdogan O, Basu H, Yang D, Choi S, Walker AJ, Carneiro-Nascimento S, He K, Wu G, Stevens B, Doran KS, Levy D, Chiu IM. Bacteria hijack a meningeal neuroimmune axis to facilitate brain invasion. Nature 2023; 615:472-481. [PMID: 36859544 PMCID: PMC10593113 DOI: 10.1038/s41586-023-05753-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
The meninges are densely innervated by nociceptive sensory neurons that mediate pain and headache1,2. Bacterial meningitis causes life-threatening infections of the meninges and central nervous system, affecting more than 2.5 million people a year3-5. How pain and neuroimmune interactions impact meningeal antibacterial host defences are unclear. Here we show that Nav1.8+ nociceptors signal to immune cells in the meninges through the neuropeptide calcitonin gene-related peptide (CGRP) during infection. This neuroimmune axis inhibits host defences and exacerbates bacterial meningitis. Nociceptor neuron ablation reduced meningeal and brain invasion by two bacterial pathogens: Streptococcus pneumoniae and Streptococcus agalactiae. S. pneumoniae activated nociceptors through its pore-forming toxin pneumolysin to release CGRP from nerve terminals. CGRP acted through receptor activity modifying protein 1 (RAMP1) on meningeal macrophages to polarize their transcriptional responses, suppressing macrophage chemokine expression, neutrophil recruitment and dural antimicrobial defences. Macrophage-specific RAMP1 deficiency or pharmacological blockade of RAMP1 enhanced immune responses and bacterial clearance in the meninges and brain. Therefore, bacteria hijack CGRP-RAMP1 signalling in meningeal macrophages to facilitate brain invasion. Targeting this neuroimmune axis in the meninges can enhance host defences and potentially produce treatments for bacterial meningitis.
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Affiliation(s)
- Felipe A Pinho-Ribeiro
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
- Division of Dermatology, John T. Milliken Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Liwen Deng
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Dylan V Neel
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Ozge Erdogan
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Himanish Basu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Daping Yang
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Samantha Choi
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Alec J Walker
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Simone Carneiro-Nascimento
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kathleen He
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Glendon Wu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Beth Stevens
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA
| | - Kelly S Doran
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dan Levy
- Harvard Medical School, Boston, MA, USA
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Isaac M Chiu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
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Holland JL, Ramgopal S, Money N, Graves C, Lo YH, Hashikawa A, Rogers A. Biomarkers and their association with bacterial illnesses in hypothermic infants. Am J Emerg Med 2023; 64:137-141. [PMID: 36528001 PMCID: PMC10368072 DOI: 10.1016/j.ajem.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To describe the association of biomarkers with serious bacterial infection (SBI; urinary tract infection [UTI], bacteremia and/or bacterial meningitis) in hypothermic infants presenting to the emergency department (ED). METHODS We performed a cross sectional study in four academic pediatric EDs from January 2015 through December 2019, including infants ≤90 days old presenting with a rectal temperature of ≤36.4 °C. We constructed receiver operating characteristic (ROC) curves to evaluate the accuracy of blood biomarkers including white blood cell count (WBC), absolute neutrophil count (ANC) and platelets for identifying SBI, with exploratory analyses evaluating procalcitonin and band counts. RESULTS Among 850 included infants (53.5% males; median days of age 13 [IQR 5-58 days]), SBI were found in 55 (6.5%). For infants with SBI, the area under the curve (AUC; 95% confidence interval) for WBC was 0.70 (0.61-0.78) with sensitivity 0.64 (0.50-0.74) and specificity 0.77 (0.74-0.80). The AUC for ANC was 0.77 (0.70-0.84) with sensitivity 0.69 (0.55-0.81) and specificity 0.77 (0.74-0.8). For platelets, the AUC was 0.6 (0.52-0.67) with sensitivity 0.73 (0.59-0.84) and specificity 0.5 (0.46-0.53). Both the WBC and ANC were minimally accurate for identifying hypothermic infants with SBI. When looking at the accuracy of these biomarkers for identifying invasive bacterial infection (IBI; bacteremia and/or bacterial meningitis), ANC again showed minimal accuracy with an AUC of 0.70 (0.55-0.85). CONCLUSIONS Biomarkers commonly used as part of an infectious workup are generally poor at identifying SBI in hypothermic infants. Our findings from this cohort of hypothermic infants are similar to those reported from febrile infants, suggesting similarities in the bioresponse to infection between hypothermic and febrile infants. Additional research is required to improve risk stratification for hypothermic infants, and to better guide evaluation and management.
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Affiliation(s)
- Jamie L Holland
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan Money
- Division of Pediatric Hospital Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher Graves
- Division of Pediatric Emergency Medicine, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Yu Hsiang Lo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Andrew Hashikawa
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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Kami L, Teixeira BCDA. Bilateral oculomotor nerve palsy secondary to bacterial meningitis. Rev Soc Bras Med Trop 2023; 56:e0564. [PMID: 36888784 PMCID: PMC9991103 DOI: 10.1590/0037-8682-0564-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Leonardo Kami
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Radiologia e Diagnóstico por Imagem, Curitiba, PR, Brasil.
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Fedorova OV, Zelikovich EI, Moseikina LA, Polunin MM, Radzig AN, Edgem SR. [Spontaneous otoliquorrhea, complicated by recurrent secondary meningitis, in a 6-year-old child with an abnormality of the inner ear]. Vestn Otorinolaringol 2023; 88:104-108. [PMID: 37970778 DOI: 10.17116/otorino202388051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Congenital anomalies in the inner ear structures development are one of the reasons for unilateral hearing loss in children. Unilateral hearing loss is predominantly congenital, thus children with this pathology are initially deprived of the ability to hear with both ears, which leads to the formation of a specific «individual hearing norm». Due to this, children do not complain of hearing loss, and unsuspecting parents can only guess why their child is poorly studying and lagging behind his peers. Unfortunately, in some situations the detection of malformations of inner ear structures occurs only after the development of complications, namely spontaneous otoliquorrea, leading to bacterial meningitis, and exactly episodes of meningitis (sometimes recurrent) become the cause for examination of patient and diagnosis of this pathology. We present one of this clinical observations.
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Affiliation(s)
- O V Fedorova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Zelikovich
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L A Moseikina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M M Polunin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Radzig
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - S R Edgem
- Pirogov Russian National Research Medical University, Moscow, Russia
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Qiu T, Lei Q, He D. Recurrent Bacterial Meningitis Caused by Transethmoidal Encephalocele. Neurology 2022; 99:1049-1050. [PMID: 36127146 DOI: 10.1212/wnl.0000000000201335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tian Qiu
- From the Department of Neurology (T.Q., D.H.), The Affiliated Hospital of Guizhou Medical University; and Department of Neurology (Q.L.), The Zhenyuan County Hospital
| | - Qian Lei
- From the Department of Neurology (T.Q., D.H.), The Affiliated Hospital of Guizhou Medical University; and Department of Neurology (Q.L.), The Zhenyuan County Hospital
| | - Dian He
- From the Department of Neurology (T.Q., D.H.), The Affiliated Hospital of Guizhou Medical University; and Department of Neurology (Q.L.), The Zhenyuan County Hospital.
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Zanotelli G, Bresciani L, Anglani M, Miscioscia A, Rinaldi F, Puthenparampil M. Case Report: Para-infectious cranial nerve palsy after bacterial meningitis. Front Immunol 2022; 13:1000912. [PMID: 36275763 PMCID: PMC9582131 DOI: 10.3389/fimmu.2022.1000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
A 27-year-old woman was admitted to our hospital for fever, associated with headache, nausea, and vomiting, and she rapidly developed mild left facial nerve palsy and diplopia. Neurological examination revealed mild meningitis associated with bilateral VI cranial nerve palsy and mild left facial palsy. As central nervous system (CNS) infection was suspected, a diagnostic lumbar puncture was performed, which revealed 1,677 cells/μl, 70% of which were polymorphonuclear leukocytes. Moreover, multiplex PCR immunoassay was positive for Neisseria meningitidis, supporting the diagnosis of bacterial meningitis. Finally, IgG oligoclonal bands (IgGOB) were absent in serum and cerebrospinal fluid (CSF). Therefore, ceftriaxone antibiotic therapy was started, and in the following days, the patient’s signs and symptoms improved, with complete remission of diplopia and meningeal signs within a week. On the contrary, left facial nerve palsy progressively worsened into a severe bilateral deficit. A second lumbar puncture was therefore performed: the CSF analysis revealed a remarkable decrease of pleocytosis with a qualitative modification (only lymphocytes), and oligoclonal IgG bands were present. A new brain MRI was performed, showing a bilateral gadolinium enhancement of the intrameatal VII and VIII cranial nerves bilaterally. Due to suspicion of para-infectious etiology, the patient was treated with oral steroid (prednisolone 1 mg/kg/day), with a progressive and complete regression of the symptoms. We suggest that in this case, after a pathogen-driven immunological response (characterized by relevant CSF mixed pleocytosis and no evidence of IgGOB), a para-infectious adaptive immunity-driven reaction (with mild lymphocyte pleocytosis and pattern III IgGOB) against VII and VIII cranial nerves started. Indeed, steroid administration caused a rapid and complete restoration of cranial nerve function.
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Affiliation(s)
- Giovanni Zanotelli
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
- *Correspondence: Giovanni Zanotelli,
| | - Lorenzo Bresciani
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | | | | | | | - Marco Puthenparampil
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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35
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Mahajan P, VanBuren JM, Tzimenatos L, Cruz AT, Vitale M, Powell EC, Leetch AN, Pickett ML, Brayer A, Nigrovic LE, Dayan PS, Atabaki SM, Ruddy RM, Rogers AJ, Greenberg R, Alpern ER, Tunik MG, Saunders M, Muenzer J, Levine DA, Hoyle JD, Lillis KG, Gattu R, Crain EF, Borgialli D, Bonsu B, Blumberg S, Anders J, Roosevelt G, Browne LR, Cohen DM, Linakis JG, Jaffe DM, Bennett JE, Schnadower D, Park G, Mistry RD, Glissmeyer EW, Cator A, Bogie A, Quayle KS, Ellison A, Balamuth F, Richards R, Ramilo O, Kuppermann N. Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics 2022; 150:e2021055633. [PMID: 36097858 PMCID: PMC9648158 DOI: 10.1542/peds.2021-055633] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
It is unknown whether febrile infants 29 to 60 days old with positive urinalysis results require routine lumbar punctures for evaluation of bacterial meningitis. OBJECTIVE To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. METHODS Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. RESULTS Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. CONCLUSIONS Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.
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Affiliation(s)
- Prashant Mahajan
- Division of Emergency Medicine, Department of Pediatrics,
Children's Hospital of Michigan, Wayne State University, Detroit,
Michigan
| | - John M. VanBuren
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | | | - Andrea T. Cruz
- Sections of Emergency Medicine and Infectious Diseases,
Department of Pediatrics, Texas Children’s Hospital, Baylor College of
Medicine, Houston, Texas
| | - Melissa Vitale
- Division of Pediatric Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth C. Powell
- Division of Emergency Medicine, Department of Pediatrics,
Ann & Robert H. Lurie Children’s Hospital, Northwestern University
Feinberg School of Medicine, Chicago, Illinois
| | - Aaron N. Leetch
- Departments of Emergency Medicine and Pediatrics,
University of Arizona College of Medicine, Tucson, Arizona
| | - Michelle L. Pickett
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anne Brayer
- Departments of Emergency Medicine and Pediatrics,
University of Rochester Medical Center, Rochester, New York
| | - Lise E. Nigrovic
- Division of Emergency Medicine, Boston Children’s
Hospital, Harvard University, Boston, Massachusetts
| | - Peter S. Dayan
- Division of Emergency Medicine, Department of
Pediatrics, Columbia University College of Physicians & Surgeons, New York
City, New York
| | - Shireen M. Atabaki
- Division of Emergency Medicine, Department of
Pediatrics, Children’s National Medical Center, The George Washington School
of Medicine and Health Sciences, Washington, District of Columbia
| | - Richard M. Ruddy
- Division of Emergency Medicine, Cincinnati
Children’s Hospital Medical Center, Department of Pediatrics, University of
Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander J. Rogers
- Departments of Pediatrics
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
| | - Richard Greenberg
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Mary Saunders
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jared Muenzer
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Deborah A. Levine
- Department of Pediatrics
- Department of Emergency Medicine, Bellevue Hospital, New
York University Langone Medical Center, New York City, New York
| | - John D. Hoyle
- Department of Emergency Medicine, Helen DeVos
Children’s Hospital of Spectrum Health, Grand Rapids, Michigan
| | - Kathleen Grisanti Lillis
- Department of Pediatrics, Women and Children’s
Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New
York
| | - Rajender Gattu
- Division of Emergency Medicine, Department of
Pediatrics, University of Maryland Medical Center, Baltimore, Maryland
| | - Ellen F. Crain
- Department of Pediatrics, Jacobi Medical Center, Albert
Einstein College of Medicine, New York City, New York
| | - Dominic Borgialli
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
- Department of Emergency Medicine, Hurley Medical Center,
Flint, Michigan
| | - Bema Bonsu
- Section of Emergency Medicine, Department of Pediatrics,
Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephen Blumberg
- Department of Pediatrics, Jacobi Medical Center, Albert
Einstein College of Medicine, New York City, New York
| | - Jennifer Anders
- Department of Pediatrics, Johns Hopkins University,
Baltimore, Maryland
| | - Genie Roosevelt
- Department of Pediatrics, The Colorado
Children’s Hospital, University of Colorado-Denver, Denver, Colorado
| | - Lorin R. Browne
- Section of Pediatric Emergency Medicine, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James G. Linakis
- Departments of Emergency Medicine and Pediatrics, Brown
University and Hasbro Children’s Hospital, Providence, Rhode Island
| | - David M. Jaffe
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Jonathan E. Bennett
- Division of Pediatric Emergency Medicine, Alfred I.
duPont Hospital for Children, Nemours Children's Health System, Wilmington,
Delaware
| | - David Schnadower
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Grace Park
- Department of Emergency Medicine, Pediatric Emergency
Medicine, The University of New Mexico, Albuquerque, New Mexico
| | - Rakesh D. Mistry
- Department of Pediatrics, The Colorado
Children’s Hospital, University of Colorado-Denver, Denver, Colorado
| | - Eric W. Glissmeyer
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Allison Cator
- Departments of Pediatrics
- Department of Emergency Medicine, University of
Michigan, Ann Arbor, Michigan
| | - Amanda Bogie
- Division of Emergency Medicine, Department of
Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City,
Oklahoma
| | - Kimberly S. Quayle
- Department of Pediatrics, St. Louis Children’s
Hospital, Washington University, St. Louis, Missouri
| | - Angela Ellison
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Fran Balamuth
- Division of Emergency Medicine, Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Rachel Richards
- Department of Pediatrics, Primary Children’s
Medical Center, University of Utah, Salt Lake City, Utah
| | - Octavio Ramilo
- Division of Pediatric Infectious Diseases and Center
for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State
University, Columbus, Ohio
| | - Nathan Kuppermann
- Departments of Emergency Medicine
- Pediatrics, University of California Davis School of
Medicine, Sacramento, California
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Meng L, Peng XL, Xu HY, Chen DD, Zhang H, Hu Y. A Nomogram to Predict Bacterial Meningitis-associated Hydrocephalus: A Single-Center Retrospective Study. Pediatr Infect Dis J 2022; 41:706-713. [PMID: 35622426 DOI: 10.1097/inf.0000000000003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to develop a predictive nomogram for the early detection of hydrocephalus in children with bacterial meningitis. METHODS This retrospective study was based on data of children with bacterial meningitis admitted to our hospital between January 2016 and December 2020. Risk factors were evaluated using univariate analysis, and the predictive model/nomogram was built using binary logistic analysis. A nomogram calibration plot, Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve evaluated the predictive performance. Ordinary bootstrapping processed the internal validation. RESULTS We enrolled 283 patients who matched the inclusion criteria, among whom 41 cases (14.49%) had confirmed bacterial meningitis-associated hydrocephalus (BMAH). The incidence of sequelae in the patients with BMAH was 88.9% (24/27), which was significantly higher than that in the patients without BMAH. Univariate regression analysis revealed that 14 clinical indicators were associated with BMAH. Multivariate analysis identified 4 variables as independent risk factors to establish the predictive model: repeated seizures, loss of consciousness, procalcitonin ≥7.5 ng/dL and mechanical ventilation. And a graphical nomogram was designed. The area under the ROC curve was 0.910. In the Hosmer-Lemeshow test the P value was 0.610. The mean absolute error in the calibration plot was 0.02. Internal validation showed the testing set was in good accordance with the original set when internal validation was performed. CONCLUSIONS The predictive model/nomogram of BMAH could be used by clinicians to determine hydrocephalus risk.
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Affiliation(s)
- Linxue Meng
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Xiao-Ling Peng
- Division of Science and Technology, Beijing Normal University-Hongkong Baptist Univesity United International College
| | - Hao-Yue Xu
- Department of Orthopedics, Joint Disease & Sport Medicine Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dou-Dou Chen
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Han Zhang
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
| | - Yue Hu
- From the Department of Neurology, Children's Hospital of Chongqing Medical University, China
- Ministry of Education Key Laboratory of Child Development and Disorders, China
- National Clinical Research Center for Child Health and Disorders, Chongqing
- China International Science and Technology Cooperation base of Child development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics
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Snoek L, Gonçalves BP, Horváth-Puhó E, van Kassel MN, Procter SR, Søgaard KK, Chandna J, van der Ende A, van de Beek D, Brouwer MC, Sørensen HT, Lawn JE, Bijlsma MW. Short-term and long-term risk of mortality and neurodevelopmental impairments after bacterial meningitis during infancy in children in Denmark and the Netherlands: a nationwide matched cohort study. The Lancet Child & Adolescent Health 2022; 6:633-642. [PMID: 35798010 PMCID: PMC9365703 DOI: 10.1016/s2352-4642(22)00155-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Background Few studies have reported the long-term consequences of bacterial meningitis during infancy, and studies that have been done usually do not include a comparison cohort. We aimed to assess short-term and long-term risk of mortality, neurodevelopmental impairment (NDI), and health-care use and household income in cohorts of children with and without a history of bacterial meningitis during infancy in Denmark and the Netherlands. Methods In this nationwide cohort study, infants with a history of bacterial meningitis before age 1 year were identified through the Danish Medical Birth Registry and Danish National Patient Registry using International Classification of Diseases (ICD)-10 codes and through the Netherlands Reference Laboratory for Bacterial Meningitis. Infants were matched (1:10) by sex and birth month and year to a comparison cohort of the general population without a history of bacterial meningitis. We analysed mortality using Cox proportional hazards regression. In Denmark, diagnoses of NDIs were based on ICD-10 codes; in the Netherlands, special educational needs were used as a functional NDI outcome. Risk ratios (RRs) of NDIs were estimated using modified Poisson regression. We also analysed long-term health-care use in Denmark and household income in both countries. All regression analyses were adjusted for sex and year of birth, and stratified by pathogen whenever sample size allowed. Findings We included 2216 children with a history of bacterial meningitis (570 [25·7%] in Denmark between Jan 1, 1997, and Dec 31, 2018, and 1646 [74·3%] in the Netherlands between Jan 1, 1995, and Dec 31, 2018), matched to 22 127 comparison cohort members. Median age at diagnosis was 2·8 months (IQR 0·4–7·1) in Denmark and 4·3 months (0·7–7·4) in the Netherlands. Mortality risks within 3 months after disease onset were 3·9% (95% CI 2·6–5·8%) in Denmark and 5·9% (4·7–7·0) in the Netherlands, compared with 0·0% (p<0·0001) and 0·1% (p<0·0001) in the comparison cohorts. Survivors had an increased risk of moderate or severe NDIs at age 10 years (RR 5·0 [95% CI 3·5–7·1] in Denmark and 4·9 [4·0–6·2] in the Netherlands) compared to children in the comparison cohort, particularly after pneumococcal and group B streptococcal meningitis. In Denmark, a history of bacterial meningitis was associated with increased health-care use in the 10 years following diagnosis (rate ratio 4·5 [95% CI 3·9–5·2] for outpatient visits and 4·1 [3·6–4·7] for hospital admissions). Interpretation Our study shows increased risk of mortality in the short and long term, a five times increase in risk of NDIs, and increased health-care use after bacterial meningitis during infancy. Together with context-specific incidence data, our results can advance pathogen-specific estimation of the meningitis burden and inform service provision at the individual and population level. Funding Bill & Melinda Gates Foundation, the Stichting Remmert Adriaan Laan Fonds, and the Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Linde Snoek
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Merel N van Kassel
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Simon R Procter
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; Department of Clinical Microbiology, Aalborg University Hospital and Aalborg University, Aalborg, Denmark
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Merijn W Bijlsma
- Department of Paediatrics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Neuroscience, Neuroinfection and Inflammation, Amsterdam, Netherlands.
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Warner JD, Tilak AM, Manickavel S, Walsh E. Cochlear implantation after deafness from Pasteurella multocida meningitis. BMJ Case Rep 2022; 15:e248557. [PMID: 35428666 PMCID: PMC9013994 DOI: 10.1136/bcr-2021-248557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/04/2022] Open
Abstract
A woman in her late 40s who works as a veterinary technician represented to the emergency department with increasing headache, confusion, neck stiffness, subjective fevers and distorted hearing 2 days after diagnosis of viral infection at an outside emergency department.Diagnosis of Pasteurella multocida was made from blood cultures and lumbar puncture. Intravenous ceftriaxone was administered for 21 days. By the time of resolution of acute meningitis, she had become completely deaf bilaterally. MRI revealed faint early ossification/possible labyrinthitis ossificans of the basal cochlea, which was confirmed on surgical exploration during the placement of cochlear implants bilaterally 42 days later. We discuss how the atypical features of this infection lead to diagnostic delay and high morbidity, the unique imaging/surgical findings resulting from the infection, and the clinical utility of early and bilateral cochlear implantation in this and similar cases.
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Affiliation(s)
- Jeffrey Dewitt Warner
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashwini Milind Tilak
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sudhir Manickavel
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erika Walsh
- Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pelkonen T, Roine I, Kallio M, Jahnukainen K, Peltola H. Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola. BMJ Open 2022; 12:e057285. [PMID: 35288394 PMCID: PMC8921951 DOI: 10.1136/bmjopen-2021-057285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM). DESIGN Secondary analysis of descriptive data from five randomised BM treatment trials. SETTING Hospitals in Finland, Latin America and Angola. PARTICIPANTS Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission. OUTCOME MEASURES Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death. RESULTS The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <-3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07. CONCLUSION Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents. TRIAL REGISTRATION NUMBER The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.
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Affiliation(s)
- Tuula Pelkonen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
- Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | - Markku Kallio
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kirsi Jahnukainen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki, Finland
| | - Heikki Peltola
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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40
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Harden LM, Leahy S, Lala SG, Paul P, Chandna J, Lowick S, Mbatha S, Jaye T, Laughton B, Ghoor A, Sithole P, Msayi J, Kumalo N, Msibi TN, Madhi SA, Lawn JE, Dangor Z. South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years. Clin Infect Dis 2022; 74:S5-S13. [PMID: 34725706 PMCID: PMC8776309 DOI: 10.1093/cid/ciab814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.
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Affiliation(s)
- Lois M Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamara Jaye
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Barbara Laughton
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela Sithole
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Msayi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntombifuthi Kumalo
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshepiso N Msibi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Manara R, Avato I, Uberti A, Trevisi P, Bovo R, Martini A, Brotto D, Berettini S, Canzi P, Ciorba A, Cristofari E, Cuda D, Della Volpe A, Frau GN, Genovese E, Marsella P, Murri A, Sorrentino F, Vincenti V, Zanetti D. Bulging of the Oval Window in Common Cavity Deformity: A Possible Predictor of Meningitis. Otol Neurotol 2022; 43:101-104. [PMID: 34699400 DOI: 10.1097/mao.0000000000003394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence-rate of oval window bulging in the common cavity and its association with bacterial meningitis. PATIENTS CT and clinical files of 29 children with preliminary diagnosis of common cavity deformity were collected from 13 Italian centers. INTERVENTION A retrospective case review study was conducted with a centralized evaluation of the temporal bone CT imaging was performed at Azienda Ospedale - Università Padova, Padova, Italy. MAIN OUTCOME MEASURE Diagnosis of common cavity was reviewed; in addition, a fluid protrusion into the middle-ear cavity through the oval window at CT imaging was considered as oval window bulging. Its association with the history of bacterial meningitis was investigated. RESULTS Common cavity deformity was confirmed in 14/29 children (mean-age 11.4 ± 3.8; age-range 5-20; nine females) referred with this diagnosis. In 7/14 patients, the common cavity deformity was bilateral (i.e., 21 common cavities). Oval window bulging was found in 3/19 common cavities (concomitant middle-ear effusive otitis hampered the evaluation in two cases), while the internal acoustic meatus fundus was defective in 10/21 cases. History of bacterial meningitis was found in three children (21%) and two of them had oval window bulging at CT. In the case unrelated to oval window bulging, meningitis occurred late at the age of 12 during acute otitis contralateral to common cavity deformity (ipsilaterally to incomplete partition type 1). CONCLUSION Patients harboring common cavity deformity have a high risk of meningitis in their first years of life. Oval window bulging seems to be associated with a higher risk of meningitis. This information might be important for appropriate surgical planning.
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Affiliation(s)
- Renzo Manara
- Neuroradiology Unit, Department of Neurosciences, University of Padova, Padova
| | - Irene Avato
- Experimental Medicine, University of Pavia, Pavia, Italy
| | - Andrea Uberti
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Patrizia Trevisi
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Roberto Bovo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Alessandro Martini
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Davide Brotto
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | | | - Pietro Canzi
- Department of Otorhinolaryngology, University of Pavia, Pavia
| | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara
| | | | | | | | | | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Modena
| | - Pasquale Marsella
- Audiology and Otosurgery Unit, "Bambino Gesù" Pediatric Hospital, Rome
- University of Parma
| | | | - Flavia Sorrentino
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova
| | - Vincenzo Vincenti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Parma; and Unit of Surgical Pathology, University of Parma, Parma
| | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Abstract
BACKGROUND Bacterial meningitis is known to cause hearing impairments and neurologic deficits; however, less is known regarding psychiatric disabilities. In this study, we assessed psychiatric disabilities and other long-term consequences of childhood bacterial meningitis. METHODS From a previously validated dataset, we selected children having had bacterial meningitis. We then reviewed medical records and child health records from discharge onwards to identify disabilities. We calculated the occurrence of disabilities with a 95% confidence interval (CI), and we used a χ test to assess possible individual risk factors associated with occurrence of disabilities. RESULTS Of the 80 children included in this study, permanent disabilities not attributed to preexisting diseases were noted in 56% (CI: 45-67) during the mean observation period of 19 years and 2 months. Psychiatric disease was diagnosed in 30% (CI: 21-41), and another 5% (CI: 2-13) were under ongoing investigations for symptoms of psychiatric disease. Hearing impairments affected at least 30% (CI: 20-40), and neurologic deficits affected at least 23% (CI: 15-34). While other disabilities were often detected within the first year, psychiatric disabilities were detected after a mean time period of 14 years (CI: 11:1-16:11). Although some associations were noted, no individual risk factor was able to predict the occurrence of disabilities. CONCLUSIONS Psychiatric disabilities affect more than one-third of survivors and are among the most common long-term consequence of childhood bacterial meningitis. Late discovery and predictive difficulties call for a revision of current guidelines to include a specific long-term strategy for detecting psychiatric disabilities.
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Affiliation(s)
- Urban Johansson Kostenniemi
- From the Department of Clinical Sciences, Pediatrics
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | | | - Linda Karlsson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
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43
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Powers HR, Nelson JR, Alvarez S, Mendez JC. Neurobrucellosis associated with feral swine hunting in the southern United States. BMJ Case Rep 2020; 13:13/12/e238216. [PMID: 33370950 DOI: 10.1136/bcr-2020-238216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.
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Affiliation(s)
- Harry Ross Powers
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jared R Nelson
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Salvador Alvarez
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Julio C Mendez
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
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44
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Trakimas DR, Knoll RM, Castillo-Bustamante M, Kozin ED, Remenschneider AK. Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans. Otolaryngol Head Neck Surg 2020; 164:175-181. [PMID: 32600100 DOI: 10.1177/0194599820934748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML). STUDY DESIGN Retrospective review. SETTING Academic institution. METHODS Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted. RESULTS Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls. CONCLUSION In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion. LEVEL OF EVIDENCE Retrospective review.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Renata M Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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45
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Esmaeilzadeh SS, Adel FW, Park JG. 63-Year-Old Woman With Fever, Generalized Weakness, and Syncope. Mayo Clin Proc 2020; 95:1506-1511. [PMID: 32622452 DOI: 10.1016/j.mayocp.2019.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Affiliation(s)
| | - Fadi W Adel
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - John G Park
- Advisor to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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46
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Orman G, Kukreja MK, Vallejo JG, Desai N, Huisman TAGM, Kralik SF. Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis. AJNR Am J Neuroradiol 2020; 41:1081-1086. [PMID: 32439638 DOI: 10.3174/ajnr.a6539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis. MATERIALS AND METHODS A retrospective review was performed among infants (age <365 days) with bacterial meningitis (n = 115). Independent and consensus blinded review of brain MRIs (n = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL. RESULTS The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0-338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose (P = .04, .02) and high CSF protein (P = .04, .03). CONCLUSIONS Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.
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Affiliation(s)
- G Orman
- From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)
| | - M K Kukreja
- From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)
| | - J G Vallejo
- Department of Pediatrics, Section of Infectious Diseases (J.G.V.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - N Desai
- From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)
| | - T A G M Huisman
- From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)
| | - S F Kralik
- From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)
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47
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Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care 2020; 32:647-666. [PMID: 32227294 PMCID: PMC7272487 DOI: 10.1007/s12028-020-00959-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, and selected non-pharmacologic therapies in the acute treatment of cerebral edema. Clinicians must be able to select appropriate therapies for initial cerebral edema management based on available evidence while balancing efficacy and safety. METHODS The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacy to create a panel in 2017. The group generated 16 clinical questions related to initial management of cerebral edema in various neurological insults using the PICO format. A research librarian executed a comprehensive literature search through July 2018. The panel screened the identified articles for inclusion related to each specific PICO question and abstracted necessary information for pertinent publications. The panel used GRADE methodology to categorize the quality of evidence as high, moderate, low, or very low based on their confidence that the findings of each publication approximate the true effect of the therapy. RESULTS The panel generated recommendations regarding initial management of cerebral edema in neurocritical care patients with subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, bacterial meningitis, and hepatic encephalopathy. CONCLUSION The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral edema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral edema in patients with bacterial meningitis, but not ICH. Differences in therapeutic response and safety may exist between HTS and mannitol. The use of these agents in these critical clinical situations merits close monitoring for adverse effects. There is a dire need for high-quality research to better inform clinicians of the best options for individualized care of patients with cerebral edema.
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Affiliation(s)
- Aaron M Cook
- UK Healthcare, University of Kentucky College of Pharmacy, Lexington, KY, USA.
| | | | | | | | | | | | - Sophie Samuel
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Sheri Tokumaru
- The Daniel K. Inouye College of Pharmacy | University of Hawaii at Hilo, Honolulu, HI, USA
| | | | - Christopher Zacko
- Penn State University Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Karen Hirsch
- Stanford University Medical Center, Stanford, CA, USA
| | - Lori Shutter
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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48
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Johansson Kostenniemi U, Karlsson L, Silfverdal SA, Mehle C. MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis. Neurocrit Care 2020; 32:586-595. [PMID: 31342450 PMCID: PMC7082372 DOI: 10.1007/s12028-019-00792-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowing the individual child's risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors. METHODS We developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a receiver operating characteristic curve (ROC) analysis to assert the area under the curve (AUC). Finally, we tested all predictive scores at their cut-off levels using a Chi-square test. As outcome, we used a small number of predefined outcomes; in-hospital mortality, 30-day mortality, occurrence of neurological disabilities at discharge defined as Pediatric Cerebral Performance Category Scale category two to five, any type of complications occurring during the hospital stay, use of intensive care, and use of invasive procedures to monitor or manage the intracerebral pressure. RESULTS For identifying children later undergoing invasive procedures to monitor or manage the intracerebral pressure, the MeningiSSS excelled in the ROC-analysis (AUC = 0.90) and also was the only predictive score able to identify all cases at its cut-off level (25 vs 0%, p < 0.01). For intensive care, the MeningiSSS (AUC = 0.79) and the Simple Luanda Scale (AUC = 0.75) had the best results in the ROC-analysis, whereas others performed less well (AUC ≤ 0.65). Finally, while none of the scores' results were significantly associated with complications, an elevated score on the MeningiSSS (AUC = 0.70), Niklasson Scale (AUC = 0.72), and the Herson-Todd Scale (AUC = 0.79) was all associated with death. CONCLUSIONS The MeningiSSS outperformed existing predictive scores at identifying children later having to undergo invasive procedures to monitor or manage the intracerebral pressure in children with bacterial meningitis. Our results need further external validation before use in clinical practice. Thus, the MeningiSSS could potentially be helpful when making difficult decisions concerning intracerebral pressure management.
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MESH Headings
- Age Factors
- Area Under Curve
- Body Temperature
- Child, Preschool
- Critical Care
- Decision Support Systems, Clinical
- Decompressive Craniectomy
- Drainage
- Female
- Functional Status
- Haemophilus Infections/complications
- Haemophilus Infections/physiopathology
- Haemophilus Infections/therapy
- Hospital Mortality
- Humans
- Intracranial Hypertension/diagnosis
- Intracranial Hypertension/etiology
- Intracranial Hypertension/physiopathology
- Intracranial Hypertension/therapy
- Intracranial Pressure
- Leukopenia/physiopathology
- Male
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/physiopathology
- Meningitis, Bacterial/therapy
- Meningitis, Meningococcal/complications
- Meningitis, Meningococcal/physiopathology
- Meningitis, Meningococcal/therapy
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/physiopathology
- Meningitis, Pneumococcal/therapy
- Monitoring, Physiologic
- Mortality
- ROC Curve
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/physiopathology
- Risk Factors
- Seizures/etiology
- Seizures/physiopathology
- Shock/etiology
- Shock/physiopathology
- Ventriculostomy
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Affiliation(s)
- Urban Johansson Kostenniemi
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87, Umeå, Sweden.
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden.
| | - Linda Karlsson
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
| | - Sven-Arne Silfverdal
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87, Umeå, Sweden
| | - Christer Mehle
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
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49
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Rayanakorn A, Katip W, Goh BH, Oberdorfer P, Lee LH. A risk scoring system for predicting Streptococcus suis hearing loss: A 13-year retrospective cohort study. PLoS One 2020; 15:e0228488. [PMID: 32017787 PMCID: PMC6999904 DOI: 10.1371/journal.pone.0228488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Streptococcus suis (S.suis) is an emerging zoonosis disease with a high prevalence in Southeast Asia. There are over 1,500 cases reported globally in which majority of cases are from Thailand followed by Vietnam. The disease leads to meningitis in human with sensorineural hearing loss (SNHL) as the most common complication suffered by the patients. Early diagnosis and treatment is important to prevent severe neurological complication. In this study, we aim to develop an easy-to-use risk score to promote early diagnosis and detection of S.suis in patients who potentially develop hearing loss. METHODS Data from a retrospective review of 13-year S.suis patient records in a tertiary hospital in Chiang Mai, Northern, Thailand was obtained. Univariate and multivariate logistic regressions were employed to develop a predictive model. The clinical risk score was constructed from the coefficients of significant predictors. Area under the receiver operator characteristic curve (AuROC) was identified to verify the model discriminative performance. Bootstrap technique with 1000-fold bootstrapping was used for internal validation. KEY RESULTS Among 133 patients, the incidence of hearing loss was 31.6% (n = 42). Significant predictors for S. suis hearing loss were meningitis, raw pork consumption, and vertigo. The predictive score ranged from 0-4 and correctly classified 81.95% patients as being at risk of S.suis hearing loss. The model showed good power of prediction (AuROC: 0.859; 95%CI 0.785-0.933) and calibration (AuROC: 0.860; 95%CI 0.716-0.953). CONCLUSIONS To our best knowledge, this is the first risk scoring system development for S.suis hearing loss. We identified meningitis, raw pork consumption and vertigo as the main risk factors of S.suis hearing loss. Future studies are needed to optimize the developed scoring system and investigate its external validity before recommendation for use in clinical practice.
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Affiliation(s)
- Ajaree Rayanakorn
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Wasan Katip
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Bey Hing Goh
- Biofunctional Molecule Exploratory Research Group (BMEX), School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Peninnah Oberdorfer
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Learn Han Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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50
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Tubiana S, Varon E, Biron C, Ploy MC, Mourvillier B, Taha MK, Revest M, Poyart C, Martin-Blondel G, Lecuit M, Cua E, Pasquet B, Preau M, Hoen B, Duval X. Community-acquired bacterial meningitis in adults: in-hospital prognosis, long-term disability and determinants of outcome in a multicentre prospective cohort. Clin Microbiol Infect 2020; 26:1192-1200. [PMID: 31927117 DOI: 10.1016/j.cmi.2019.12.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/24/2019] [Accepted: 12/29/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify factors associated with unfavourable in-hospital outcome (death or disability) in adults with community-acquired bacterial meningitis (CABM). METHODS In a prospective multicentre cohort study (COMBAT; February 2013 to July 2015), all consecutive cases of CABM in the 69 participating centres in France were enrolled and followed up for 12 months. Factors associated with unfavourable outcome were identified by logistic regression and long-term disability was analysed. RESULTS Among the 533 individuals enrolled, (Streptococcus pneumoniae 53.8% (280/520 isolates identified), Neisseria meningitidis 21.3% (111/520), others 24.9% (129/520)), case fatality rate was 16.9% (90/533) and unfavourable outcome occurred in 45.0% (225/500). Factors independently associated with unfavourable outcome were: age >70 years (adjusted odds ratio (aOR) 4.64; 95% CI 1.93-11.15), male gender (aOR 2.11; 95% CI 1.25-3.57), chronic renal failure (aOR 6.65; 95% CI 1.57-28.12), purpura fulminans (aOR 4.37; 95% CI 1.38-13.81), localized neurological signs (aOR 3.72; 95% CI 2.29-6.05), disseminated intravascular coagulation (aOR 3.19; 95% CI 1.16-8.79), cerebrospinal fluid (CSF) white-cell count <1500 cells/μL (aOR 2.40; 95% CI 1.42-4.03), CSF glucose concentration (0.1-2.5 g/L: aOR 1.92; 95% CI 1.01-3.67; <0.1 g/L: aOR 2.24; 95% CI 1.01-4.97), elevated CSF protein concentration (aOR 1.09; 95% CI 1.03-1.17), time interval between hospitalization and lumbar puncture >1 day (aOR 2.94; 95% CI 1.32-6.54), and S. pneumoniae meningitis (aOR 4.99; 95% CI 1.98-12.56), or meningitis other than N. meningitidis (aOR 4.54; 95% CI 1.68-12.27). At 12 months, 26.7% (74/277) had hearing loss, 32.8% (87/265) depressive symptoms, 31.0% (86/277) persistent headache, and 53.4% had a physical health-related quality of life (142/266) <25th centile of the distribution of the score in the general French population (p < 0.0001). CONCLUSIONS The burden of CABM (death, disability, depression, impaired quality of life and hearing loss) is high. Identification of cases from the first symptoms may improve prognosis. CLINICALTRIAL Gov identification number: NCT01730690.
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Affiliation(s)
- S Tubiana
- Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France.
| | - E Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Biron
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - M-C Ploy
- CHU Limoges, Observatoires Régionaux Du Pneumocoque, Limoges, France
| | - B Mourvillier
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris University, Paris, France
| | - M-K Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, INSERM U 1230, CHU Rennes, Rennes University, Rennes, France
| | - C Poyart
- Department of Bacteriology, University Hospitals Paris Centre-Cochin, French National Centre for Streptococci, APHP, France
| | - G Martin-Blondel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France; INSERM, UMR1043, Toulouse, France
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, INSERM U1117, National Reference Centre and WHO Collaborating Center for Listeria, Paris, France; Université de Paris, Hôpital Universitaire Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Institut Imagine, APHP, Paris, France
| | - E Cua
- Infectious Diseases Department, CHU Nice, France
| | - B Pasquet
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Unité de Recherche Clinique Paris Nord, Paris, France
| | - M Preau
- GRePS, Lyon 2 University, Lyon, France
| | - B Hoen
- CHU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Vandœuvre-lès-Nancy, France
| | - X Duval
- Paris University, IAME, INSERM, Paris, France; Inserm Clinical Investigation Centre 1425, Paris, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
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