scholarly journals Cerebrospinal Fluid and Plasma Procalcitonin for the Diagnosis of Neonatal Bacterial Meningitis

2021 ◽  
Author(s):  
Sourabh Dutta ◽  
Naresh Sachdeva ◽  
Vilay Sanger ◽  
Arnab Pal ◽  
Pallab Ray
Keyword(s):  
Bacterial Meningitis ◽  
Leukocyte Count ◽  
A Priori ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Area Under Roc Curve ◽  
Level 3 ◽  
Polymerase Chain ◽  
Index Tests ◽  
Study Setting

Objective: To determine accuracy of cerebro-spinal fluid (CSF) procalcitonin (PCT) to diagnose neonatal bacterial meningitis (NBM) among septic neonates and compare with other index tests. Design: Prospective, cross-sectional, single-gate study Setting: Level-3 neonatal unit Patients: Neonates with suspected sepsis undergoing lumbar puncture Index tests: CSF PCT, leukocyte count and biochemistry; plasma PCT and CSF:plasma PCT ratio Reference standards ″Definite meningitis″ defined by positive CSF culture and/or gram stain and/or broad-based primer 16S rDNA polymerase chain reaction. ″Definite or probable meningitis″ defined by definite meningitis or probable meningitis (based on cytochemistry cut-offs). Results: Of 216 eligible neonates, 18 had ″definite meningitis″ and 37 ″definite or probable meningitis″. Median (Q1, Q3) CSF PCT level was higher in ″definite meningitis″ compared to ″no definite meningitis″ [0.429 (0.123, 1.300) vs. 0.181 (0.119, 0.286) ng/ml respectively, p=0.028]. Likewise, it was higher in ″definite or probable meningitis″ compared to no meningitis [0.245 (0.136, 0.675) vs. 0.170 (0.116, 0.28), p=0.01]. The area under ROC curve (AUC) of CSF PCT level for definite meningitis was 0.656 and for ″definite or probable meningitis″ 0.635. Paired comparisons of AUC of CSF PCT with other index tests were not significant. Based on a priori cut-off of 0.2 ng/ml, CSF PCT level had a sensitivity (95% CI) of 67% (50, 80), specificity 58% (54, 61), LR+ 1.6 (1.1, 2.0) and LR- 0.6 (0.3, 0.9). Conclusions: Higher values of CSF PCT are associated with NBM. CSF PCT cannot reliably discriminate between meningitis and no meningitis and is not superior to other CSF tests.

scholarly journals Frequency of sensorineural hearing loss in children with bacterial meningitis.

2020 ◽  
Vol 27 (12) ◽  
pp. 2729-2733
Author(s):  
Rabia Saleem Safdar ◽  
M Faisal Mehar ◽  
Madiha Naz ◽  
Afsheen Asghar Khan ◽  
Nusrat Buzdar ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Bacterial Meningitis ◽  
Sensorineural Hearing Loss ◽  
Cross Sectional Study ◽  
Sensorineural Hearing ◽  
Outcome Variable ◽  
Cross Sectional ◽  
And Gender ◽  
Evoked Response Audiometry ◽  
Study Setting

Objectives: To determine the frequency of sensorineural hearing loss (SNHL) in children with bacterial meningitis. Study Design: Cross Sectional study. Setting: Department of Paediatric Medicine Nishtar Hospital, Multan. Period: October 2019 to March 2020. Material & Methods: The study was conducted after permission from ethical committee. A total of 151 patients admitted with bacterial meningitis were enrolled. Apart from the presenting complaints, necessary information like the age and gender were noted. Examination of the child was done to assess the condition of child. Brainstem evoked response audiometry (BERA) test was performed before discharge of the patient from the hospital. The outcome variable that is SNHL in bacterial meningitis assessed by BERA test was noted in a specifically designed Performa. Results: Out of total of 151 patients, males were 83 (55%) while females 68 (45%). Overall mean age was 11.85+6.12 months. SNHL was found in 26 (17.2%) children. There was no significant effect of age or gender on the frequencies of SNHL. Conclusion: SNHL is a frequently encountered complication in our population of children with bacterial meningitis. SNHL should be carefully sought out and properly diagnosed in all the patients presenting with bacterial meningitis.

scholarly journals Haemophilus influenzae infection among children with acute bacterial meningitis.

2021 ◽  
Vol 28 (11) ◽  
pp. 1621-1625
Author(s):  
Muhammad Shahzad Maqsood ◽  
Safdar Hussain ◽  
Asim Khurshid
Keyword(s):  
Bacterial Meningitis ◽  
Haemophilus Influenzae ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Acute Bacterial Meningitis ◽  
Microbiological Analysis ◽  
Haemophilus Influenza ◽  
Cross Sectional ◽  
Duration Of Illness ◽  
Study Setting

Objective: To determine the frequency of haemophilus influenzae infection in children less than 5 years with acute bacterial meningitis (ABM). Study Design: Descriptive Cross Sectional study. Setting: Department of Pediatric Medicine, The Children’s Hospital and Institute of Child Health, Multan. Period: October 2019 to March 2020. Material & Methods: A total of 165 children aged 5 – 60 months of either gender having acute bacterial meningitis with duration of < 2 weeks were enrolled. Cerebrospinal fluid (CSF) of each child was sent for microbiological analysis. Results: There were 106 (64.2 %) boys and 59 (35.8 %) girls. Mean age was 2.72 ± 1.07 years. Most cases, 112 (67.9 %) belonged to urban areas.  Maternal literacy was positive in 65 (39.4%) cases while 59 (35.8%) were fully vaccinated. Mean disease duration was 56.25 ± 15.36 hours and 112 (67.9%) had duration of illness more than 36 hours. Frequency of Haemophilus Influenzae was noted in 35 (21.2%) cases. Conclusion: Frequency of Haemophilus Influenzae was high among children with acute bacterial meningitis. Early diagnosis and appropriate management might help reducing prolonged hospitalization and disease morbidity related to Haemophilus Influenza.

scholarly journals CORRELATION OF SERUM CYTOKINE INTERLEUKIN-6, TNF- α PROCALCITONIN AND LEUKOCYTE COUNT IN PATIENTS WITH SUSPECTED SEPSIS

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Erfina Lim ◽  
Jusak Nugraha
Keyword(s):  
Negative Correlation ◽  
Leukocyte Count ◽  
Mean Value ◽  
Specific Marker ◽  
Serum Cytokine ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Tnf Α ◽  
Leukocyte Counts ◽  
Weak Negative Correlation

Introduction. Sepsis is a cause of non-cardiac death in the hospital. Early and rapid diagnosis of sepsis patients is a challenge to increase the expectancy of life. IL-6 and TNF-α are groups of proinflammatory cytokines that initiate an initial inflammatory response. Procalcitonin is a specific marker of bacterial infection. This study aimed to analyze the correlation of serum cytokine IL-6, TNF-α, procalcitonin and leukocyte count in  suspected sepsis patients.Methods. This was a cross-sectional observational study.  The study subjects consisted of 45 patients with suspected sepsis who were examined for procalcitonin level > 0.5 ng/mL. Procalcitonin examination by  ELFA (VIDAS) , IL-6 and TNF- α used U-CyTech Human Elisa kit (Bioscience, INC) and leukocyte counts with SYSMEX-XN 1000.Results. The levels of IL-6 ranged 0 pg/mL – 73.29 ng/mL (mean 29.43 ng/mL). The values for TNF- α were 0 pg/mL – 390.5 pg/mL (mean 27.62 pg/mL). The mean value of  leukocytes was 20,139/ μL. There was no correlation between leukocyte counts with IL-6 ( p = 0.798 and r = 0.040),  TNF- α (p = 0.304 and r = -0.160),  Procalcitonin ( p = 0.323 and r = 0.154). There was no correlation between  IL-6 levels with  TNF-α levels (p = 0.871 and r = -0.025), procalcitonin levels ( p = 0.466 and r = 0.112).  There was a weak negative correlation between TNF- α  level and procalcitonin levels ( p=0.006 and r = -0.403)Conclusion. There was a weak negative correlation between the level of procalcitonin with TNF- α in suspected sepsis patients.

scholarly journals 425. The Utility of Paired Upper and Lower COVID-19 Sampling in Patients with Artificial Airways

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S279-S279
Author(s):  
Eimear Kitt ◽  
Julia S Sammons ◽  
Kathleen Chiotos ◽  
Susan E Coffin ◽  
Susan E Coffin ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Diagnostic Testing ◽  
Cross Sectional Study ◽  
Upper Respiratory Tract ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Paired Samples ◽  
Control And Prevention ◽  
Polymerase Chain

Abstract Background The Centers for Disease Control and Prevention (CDC) recommends upper respiratory tract (URT) polymerase chain reaction (PCR) testing as the initial diagnostic test for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Lower respiratory tract (LRT) testing for patients requiring mechanical ventilation is also recommended. The goal of this study was to evaluate concordance between paired URT and LRT specimens in children undergoing pre-admission/procedure screening or diagnostic testing. We hypothesized that &lt; 10% of paired tests would have discordant results. Methods Single center cross-sectional study including children with artificial airways who had paired URT and LRT SARS-CoV-2 PCR testing between 4/1/2020 and 6/8/2020. URT specimens included nasopharyngeal (NP) swabs and aspirates. LRT specimens included tracheal aspirates and bronchoalveolar lavages. URT and LRT specimens were classified as paired if the two specimens were collected within 24 hours. Artificial airways included tracheostomies and endotracheal tubes. Tests were classified as diagnostic versus screening based on the indication selected in the order. Results 102 paired specimens were obtained during the study period. Fifty-nine were performed for screening and 43 were performed for diagnosis of suspected SARS-CoV-2. Overall, 94 specimens (92%) were concordant, including 89 negative from both sources and 5 positive from both sources. Eight specimens (8%) were discordant, all of which were positive from the URT and negative from the LRT (Figure 1). Among patients undergoing screening, 3 of 4 positive tests were discordant and among symptomatic patients, 5 of 9 positive tests were discordant. There were no instances of a positive LRT specimen with a negative URT specimen. Figure 1. Performance of upper and lower respiratory tract SARS-CoV-2 PCR testing in children with artificial airways Conclusion Overall, most paired samples from the URT and LRT yielded concordant results with no pairs positive from the LRT and negative from the URT. These data support the CDC recommendation that URT specimens are the preferred initial SARS-CoV-2 test, while LRT specimens should be collected only from mechanically ventilated with suspected SARS-CoV-2. Disclosures All Authors: No reported disclosures

scholarly journals Estimating epidemiologic dynamics from cross-sectional viral load distributions

Science ◽  
2021 ◽  
pp. eabh0635
Author(s):  
James A. Hay ◽  
Lee Kennedy-Shaffer ◽  
Sanjat Kanjilal ◽  
Niall J. Lennon ◽  
Stacey B. Gabriel ◽  
...  
Keyword(s):  
Population Distribution ◽  
Quantitative Polymerase Chain Reaction ◽  
Cross Sectional ◽  
Outbreak Management ◽  
Viral Loads ◽  
Time Estimates ◽  
Load Distributions ◽  
Random Samples ◽  
Combining Data ◽  
Polymerase Chain

Estimating an epidemic’s trajectory is crucial for developing public health responses to infectious diseases, but case data used for such estimation are confounded by variable testing practices. We show that the population distribution of viral loads observed under random or symptom-based surveillance, in the form of cycle threshold (Ct) values obtained from reverse-transcription quantitative polymerase chain reaction testing, changes during an epidemic. Thus, Ct values from even limited numbers of random samples can provide improved estimates of an epidemic’s trajectory. Combining data from multiple such samples improves the precision and robustness of such estimation. We apply our methods to Ct values from surveillance conducted during the SARS-CoV-2 pandemic in a variety of settings and offer alternative approaches for real-time estimates of epidemic trajectories for outbreak management and response.

scholarly journals Stillbirth outcome capture and classification in population-based surveys: EN-INDEPTH study

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Hannah Blencowe ◽  
◽  
Matteo Bottecchia ◽  
Doris Kwesiga ◽  
Joseph Akuze ◽  
...  
Keyword(s):  
Gestational Age ◽  
A Priori ◽  
Healthcare Providers ◽  
Population Based ◽  
Reproductive Age ◽  
Group Discussions ◽  
Cross Sectional ◽  
Vital Status ◽  
Neonatal Deaths ◽  
Adverse Pregnancy

Abstract Background Household surveys remain important sources of stillbirth data, but omission and misclassification are common. Classifying adverse pregnancy outcomes as stillbirths requires accurate reporting of vital status at birth and gestational age or birthweight for every pregnancy. Further categorisation, e.g. by sex, or timing (intrapartum/antepartum) improves data to understand and prevent stillbirth. Methods We undertook a cross-sectional population-based survey of women of reproductive age in five health and demographic surveillance system sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). All women answered a full birth history with pregnancy loss questions (FBH+) or a full pregnancy history (FPH). A sub-sample across both groups were asked additional stillbirth questions. Questions were evaluated using descriptive measures. Using an interpretative paradigm and phenomenology methodology, focus group discussions with women exploring barriers to reporting birthweight for stillbirths were conducted. Thematic analysis was guided by an a priori codebook. Results Overall 69,176 women reported 98,483 livebirths (FBH+) and 102,873 pregnancies (FPH). Additional questions were asked for 1453 stillbirths, 1528 neonatal deaths and 12,620 surviving children born in the 5 years prior to the survey. Completeness was high (> 99%) for existing FBH+/FPH questions on signs of life at birth and gestational age (months). Discordant responses in signs of life at birth between different questions were common; nearly one-quarter classified as stillbirths on FBH+/FPH were reported born alive on additional questions. Availability of information on gestational age (weeks) (58.1%) and birthweight (13.2%) was low amongst stillbirths, and heaping was common. Most women (93.9%) were able to report the sex of their stillborn baby. Response completeness for stillbirth timing (18.3–95.1%) and estimated proportion intrapartum (15.6–90.0%) varied by question and site. Congenital malformations were reported in 3.1% stillbirths. Perceived value in weighing a stillborn baby varied and barriers to weighing at birth a nd knowing birthweight were common. Conclusions Improving stillbirth data in surveys will require investment in improving the measurement of vital status, gestational age and birthweight by healthcare providers, communication of these with women, and overcoming reporting barriers. Given the large burden and effect on families, improved data must be made available to end preventable stillbirths.

scholarly journals SARS-CoV-2 infection is at herd immunity in the majority segment of the population of Qatar

2021 ◽  
Author(s):  
Mohamed H Al-Thani ◽  
Elmoubasher Farag ◽  
Roberto Bertollini ◽  
Hamad Eid Al Romaihi ◽  
Sami Abdeen ◽  
...  
Keyword(s):  
Total Population ◽  
Herd Immunity ◽  
Geographic Location ◽  
Population Based ◽  
Infection Prevalence ◽  
Cross Sectional ◽  
Previous Infection ◽  
Current Infection ◽  
Polymerase Chain ◽  
Population Based Survey

Abstract Background Qatar experienced a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual worker (CMW) population who comprise 60% of the total population. This study aimed to assess ever and/or current infection prevalence in this population. Methods A cross-sectional population-based survey was conducted during July 26-September 09, 2020 to assess both anti-SARS-CoV-2 positivity through serological testing and current infection positivity through polymerase chain reaction (PCR) testing. Associations with antibody and PCR positivity were identified through regression analyses. Results Study included 2,641 participants, 69.3% of whom were &lt;40 years of age. Anti-SARS-CoV-2 positivity was 55.3% (95% CI: 53.3-57.3%) and was significantly associated with nationality, geographic location, educational attainment, occupation, and previous infection diagnosis. PCR positivity was 11.3% (95% CI: 9.9-12.8%) and was significantly associated with nationality, geographic location, occupation, contact with an infected person, and reporting two or more symptoms. Infection positivity (antibody and/or PCR positive) was 60.6% (95% CI: 58.6-62.5%). The proportion of antibody-positive CMWs that had a prior SARS-CoV-2 diagnosis was 9.3% (95% CI: 7.9-11.0%). Only seven infections were ever severe and one was ever critical—an infection severity rate of 0.5% (95% CI: 0.2-1.0%). Conclusions Six in every 10 CMWs have been infected, suggestive of reaching the herd immunity threshold. Infection severity was low with only one in every 200 infections progressing to be severe or critical. Only one in every 10 infections had been previously diagnosed suggestive of mostly asymptomatic or mild infections.

scholarly journals Discharge against medical advice from the emergency department in a university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feras H. Abuzeyad ◽  
Moonis Farooq ◽  
Salah Farhat Alam ◽  
Mudhaffar Ismael Ibrahim ◽  
Luma Bashmi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Medical Advice ◽  
University Hospital ◽  
High Risk Population ◽  
Cross Sectional ◽  
Against Medical Advice ◽  
Level 3 ◽  
Collection Form

Abstract Background Patients discharged against medical advice (DAMA) act as a high-risk population for the Emergency Department (ED), regardless of their presentations, and can pose a serious burden for the hospital. This study examines the prevalence, demographic and clinical characteristics, reasons, and clinical outcomes of a small sample of DAMA patients in a teaching university hospital, including readmission, morbidity, and mortality. Methods A prospective, descriptive cross-sectional study was conducted in the ED of King Hamad University Hospital (KHUH) with 98,992 patient visits during a 1-year period from June 2018 to June 2019. Consenting DAMA patients were asked to complete a data collection form. Results Patients (n = 413) had a mean age of 44.1 years with a female majority (57.1%). The majority were categorized as triage level-3 (87.7%). The main reasons for DAMA included refusal of the procedure/operation (23.2%), long ED waiting time (22.2%), subjective improvement with treatment (17.7%), and children at home (14.8%), whereas the least selected reason was dissatisfaction with medical care (1.2%). Follow-up of DAMA patients revealed that 86 cases (20.8%) were readmitted to the ED within 72 h of which 41 (47.7%) cases were morbidity and 2 (2.3%) were mortality. Marital status was a predictor of DAMA patients who revisit the ED within 72 h. Conclusion The results act as a pilot study to examine a small sample of DAMA patients’ characteristics, diagnosis, and ED revisits. Hospitals should investigate further the DAMA population on a larger scale, reasons for refusing procedures, and utilize this knowledge to improve the healthcare process.

West Nile Virus Chorioretinitis in the Presence of Negative Cerebrospinal Fluid Polymerase Chain Reaction Results

2021 ◽  
pp. 247412642097925
Author(s):  
Kareem Moussa ◽  
Karen W. Jeng-Miller ◽  
Leo A. Kim ◽  
Dean Eliott
Keyword(s):  
Cerebrospinal Fluid ◽  
West Nile Virus ◽  
Cross Sectional Study ◽  
Nucleic Acid Amplification ◽  
Sectional Study ◽  
Chain Reaction ◽  
West Nile ◽  
Cross Sectional ◽  
Positive Serum ◽  
Polymerase Chain

Purpose: This work aims to evaluate the utility of nucleic acid amplification testing (NAAT) and serology in confirming West Nile Virus (WNV) infection in patients with suspected WNV chorioretinitis. Methods: A retrospective cross-sectional study was conducted of a cluster of patients who presented to the Retina Service of Massachusetts Eye and Ear between September and October 2018. Results: Three patients were identified with classic WNV chorioretinitis lesions with negative cerebrospinal fluid NAAT and positive serum serology findings. The diagnosis of WNV chorioretinitis was made based on the appearance of the fundus lesions and the presence of characteristic findings on fluorescein angiography as previously described in the literature. Conclusions: This report highlights 3 unique cases of WNV chorioretinitis in which NAAT of cerebrospinal fluid failed to identify WNV as the inciting agent. These cases stress the importance of serum serologic testing in diagnosing WNV infection.

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