scholarly journals 1399. A Prospective Cohort Study Regarding the Impact of Biofire® FilmArray® Meningitis/Encephalitis (FA) Panel in Children with Suspected Central Nervous System Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S509-S509
Author(s):  
Lamprini Posnakoglou ◽  
Vasiliki Syriopoulou ◽  
Tania Siahanidou ◽  
Eleni Atmatzidou ◽  
Triantafyllos Syriopoulos ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Cohort Study ◽  
Aseptic Meningitis ◽  
Prospective Cohort ◽  
Cns Infection ◽  
Control Group ◽  
Total Cost ◽  
Hospitalization Cost

Abstract Background Rapid detection of pathogens involved in central nervous system (CNS) infections could be important for the optimal patient management and overall hospitalization cost. The aim of the study was to evaluate the possible benefits with the use of BioFire® FilmArray® meningitis/encephalitis (FA) panel in children with suspected CNS infection. Methods A prospective cohort study, was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year (April 2018–April 2019), with possible CNS infection and cerebrospinal fluid (CSF) pleocytosis (>15 cells/mm3). For each child that FA was used for the diagnosis, an age-matched control was selected, and separate molecular CSF microbiological tests were sent according to pediatrician’s discretion. Conventional microbiological procedures were performed in all children. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. FA enables rapid automated cerebrospinal fluid testing for 14 common viral, bacterial and yeast pathogens that cause CNS infections. The cost was estimated according to ICD-10 diagnosis standard cost, adding additional daily hospitalization cost, FA or other molecular microbiological tests costs. Results A total of 142 children were included in the study (71 cases). The median age of cases and controls was 2.5 months (IQR: 1–72) and 2 months (IQR: 0.7–36) respectively (P = 0.157). A pathogen was detected in 38/71 (53.5%) children with the use of FA and in 16/71 (22.5%) in the control group (P < 0.001). In aseptic meningitis cases a virus was detected in 27/60 (45%) and in 11/64 (16.4%) controls (P < 0.001). Length of stay in cases and controls with aseptic meningitis was 5 days (IQR: 4–8) and 8 (IQR: 6–10) respectively (P < 0.001). The median duration of antimicrobials in cases was 4 days (IQR: 2–5.7) and 7 (IQR: 5–10) respectively (P < 0.001). The hospitalization cost was calculated in cases and controls 1,042 (IQR: 932–1372€) and 1,522 (IQR: 1,302–1,742€) respectively (P < 0.001). Conclusion The use of FA was able to reduce significantly the hospitalization days and the total cost comparing to the control group in children with suspected CNS infection. Disclosures All authors: No reported disclosures.

scholarly journals CLINICAL-EPIDEMIOLOGICAL CHARACTERISTICS OF ASEPTIC MENINGITIS IN CHILDREN OF KHMELNITSKYI REGION (PODILSKYI REGION, UKRAINE): FOURTEEN-YEAR EPIDEMIOLOGICAL OBSERVATION

2019 ◽  
Vol 11 (1) ◽  
pp. 41-45
Author(s):  
L. V. Pypa ◽  
R. V. Svistilnik ◽  
Yu. N. Lysytsia ◽  
K. Yu. Romanchuk ◽  
I. V. Odarchuk
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Aseptic Meningitis ◽  
Clinical Picture ◽  
Epileptic Seizures ◽  
Complete Recovery ◽  
The Central Nervous System ◽  
Meningitis In Children ◽  
Epidemiological Characteristics

Aim of work – to analyze the etiological structure, epidemiological structure, social-demographic features and the nature of the development of complications of the central nervous system in aseptic meningitis in children in Khmelnitskyi region for the period 2004-2017.Materials and methods. It was conducted a prospective analysis of 208 cases of aseptic meningitis in children of whom 138 people were boys and 70 people were girls. The etiology of the disease was determined by studying cerebrospinal fluid using PCR method. Complications of the central nervous system were diagnosed on the basis of the clinical picture and CT or MRI scans. The analytical method was used to conduct the analysis of the received data.Results. The highest seasonal increase of the incidence was from August to October and it was 65.6% with its peak in September (24.0%). The clinical picture was characterized by a moderate trend in 71.2% of cases and in 28.8% by a severe course. In 100% of cases the disease began with a fever, headache (83.6%), vomiting (76.9%), abdominal pain with diarrhea (6.2%), epileptic seizures (0.9%). The average level of cytosis was 269.4±196.7 cells/mm3with a predominance of lymphocytes and the average protein level in cerebrospinal fluid was 73 ± 36 mg/dl. The etiological factor was established in 18 (8.6%) patients.Conclusions. Enterovirus remains to be the main pathogen which was determined in 72.2% of cases. The second place was taken by herpes viruses (22.2% of cases), the third place was given to the mumps virus (5.6% of cases) (in etiologically verified cases). In most cases the disease ended in complete recovery but in 47 (22.6%) patients the complications were observed. The prevalence of aseptic meningitis among children in Khmelnitskyi region was 6.2 per 100,000 children, and males outnumbered females by a 2:1 ratio.

scholarly journals Decreased Asialotransferrin in Cerebrospinal Fluid of Patients with Childhood-Onset Ataxia and Central Nervous System Hypomyelination/Vanishing White Matter Disease

2005 ◽  
Vol 51 (11) ◽  
pp. 2031-2042 ◽  
Author(s):  
Adeline Vanderver ◽  
Raphael Schiffmann ◽  
Margaret Timmons ◽  
Katherine A Kellersberger ◽  
Dan Fabris ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
White Matter ◽  
Control Group ◽  
White Matter Disease ◽  
Childhood Onset ◽  
Vanishing White Matter Disease ◽  
Vanishing White Matter

Abstract Background: A biomarker for the diagnosis of childhood-onset ataxia and central nervous system hypomyelination (CACH)/vanishing white matter disease (VWM) would have clinical utility and pathophysiologic significance. Methods: We used 2-dimensional gel electrophoresis/mass spectrometry to compare the cerebrospinal fluid proteome of patients with mutation-confirmed CACH/VWM with that of unaffected controls. We characterized selected spots by in-gel digestion, matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry, and nanospray Fourier transform mass spectrometry. Results: A specific transferrin spot pattern was detected in the CSF samples of the CACH/VWM group (n = 7), distinguishing them from the control group (n = 23) and revealing that patients with CACH/VWM have a deficiency of the asialo form of transferrin usually present in healthy cerebrospinal fluid. The glycopeptide structure, determined from isolated transferrin spots by use of in-gel digestion and extraction, was found to be consistent with earlier reports. Conclusions: The transferrin isoform abnormality in the cerebrospinal fluid of patients with CACH/VWM appears unique and is a potential clinical diagnostic biomarker. The rapid, efficient diagnosis of this disorder would have a significant impact on clinical studies exploring new strategies for the management and treatment of this disease.

scholarly journals Fetal central nervous system anomalies according to RT‐PCR and trimester of maternal infection with Zika virus: A prospective cohort study

2021 ◽  
Author(s):  
Luz Ángela Gutiérrez‐Sánchez ◽  
Carlos Hernán Becerra‐Mojica ◽  
Mario Augusto Rojas ◽  
Luis Alfonso Díaz‐Martínez ◽  
Luis Alfonso Pérez Vera ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Zika Virus ◽  
Prospective Cohort ◽  
Maternal Infection ◽  
Rt Pcr ◽  
Central Nervous System Anomalies

scholarly journals When Ventricular Cerebrospinal Fluid Assessment Misleads: Basal Meningitis and the Importance of Lumbar Puncture Sampling

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Sadid F Khan ◽  
Thornton Macauley ◽  
Steven Y C Tong ◽  
Ouli Xie ◽  
Carly Hughes ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Lumbar Puncture ◽  
Cns Infection ◽  
Pathophysiological Mechanisms ◽  
Cns Infections ◽  
Fluid Assessment ◽  
Composition Gradients

Abstract The diagnosis of central nervous system (CNS) infection relies upon analysis of cerebrospinal fluid (CSF). We present 4 cases of CNS infections associated with basal meningitis and hydrocephalus with normal ventricular CSF but grossly abnormal lumbar CSF. We discuss CSF ventricular–lumbar composition gradients and putative pathophysiological mechanisms and highlight clinical clues for clinicians.

Cerebrospinal Fluid Analysis in Systemically Ill Children Without Central Nervous System Disease

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 48-51
Author(s):  
Carol Carraccio ◽  
Krystyna Blotny ◽  
Margaret C. Fisher
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Blood Cell ◽  
Neutrophil Count ◽  
Cns Infection ◽  
Blood Cell Count ◽  
Diagnostic Categories ◽  
Close Proximity ◽  
Focus Of Infection

Objective. Experience led us to question the applicability of standards for normal cerebrospinal fluid (CSF), originally developed in healthy children, to children with systemic illness but without central nervous system (CNS) infection. The purpose of this study was to test our hypothesis that systemically ill children, in the absence of CNS infection, have an elevated CSF white blood cell count and a greater percentage of neutrophils than accepted norms. Methods. We enrolled 345 patients in the following diagnostic categories: infants 1 month of age or younger with possible sepsis (n = 95), patients older than 1 month of age with possible sepsis (n = 155), patients with a focus of infection in close proximity to the CNS (n = 51), and patients presenting with seizures and fevers (n = 45). Sociodemographic data and results of CSF examination were abstracted from the medical records. Statistical analysis systems were used for data processing. Results. The CSF white blood cell count did not significantly differ from standards except for a lower mean count in the group presenting with seizures. The percent of CSF neutrophils was significantly greater than standards, however, for those patients older than 1 month of age with possible sepsis, those with a focus of infection in close proximity to the CNS, and those presenting with seizures. Data analysis by quantiles shows only 25% to 50% of patients, in each of the diagnostic categories, meeting the current definition of normal CSF neutrophil count. Conclusions. Our results show that a mean of at least 5% neutrophils may be present in the CSF with a diagnosis of fever without a source, a focus of infection in close proximity to the CNS, or a seizure with fever in the absence of CNS infection. These data support tailoring treatment based on clinical assessment rather than what is considered an abnormal CSF neutrophil count by current standards.

Central Nervous System Infection in Patients with Postirradiated Nasopharyngeal Carcinoma: A Case-Controlled Study

2009 ◽  
Vol 23 (4) ◽  
pp. 417-421 ◽  
Author(s):  
Kai-Li Liang ◽  
Rong-San Jiang ◽  
Jin-Ching Lin ◽  
Yu-Jung Chiu ◽  
Jiun-Yih Shiao ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Nasopharyngeal Carcinoma ◽  
Skull Base ◽  
Sinus Thrombosis ◽  
Central Nervous System Infection ◽  
Controlled Study ◽  
Cns Infection ◽  
Control Group ◽  
Significant Difference

Background It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection. Objective The purpose of this study was to better understand this clinical entity. Methods From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated. Results The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001). Conclusions Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.

Central Nervous System Infections

2016 ◽  
Author(s):  
Nicholas J. Johnson ◽  
David F. Gaieski
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Cns Infection ◽  
Cns Infections ◽  
Associated Conditions

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections.   This review contains 8 highly rendered figures, 7 tables, and 94 references

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