scholarly journals Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

2018 ◽  
Vol 56 (11) ◽  
Author(s):  
Ryan M. Martin ◽  
Lara L. Zimmermann ◽  
Mindy Huynh ◽  
Christopher R. Polage
Keyword(s):  
Health Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Diagnostic Approach ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Neurosurgical Patients ◽  
Definition Of

ABSTRACTHealth care- and device-associated central nervous system (CNS) infections have a distinct epidemiology, pathophysiology, and microbiology that require a unique diagnostic approach. Most clinical signs, symptoms, and tests used to diagnose community-acquired CNS infections are insensitive and nonspecific in neurosurgical patients due to postsurgical changes, invasive devices, prior antimicrobial exposure, and underlying CNS disease. The lack of a standardized definition of infection or diagnostic pathway has added to this challenge. In this review, we summarize the epidemiology, microbiology, and clinical presentation of these infections, discuss the issues with existing microbiologic tests, and give an overview of the current diagnostic approach.

Epidemiology, diagnosis, and assessment of meningitis and encephalitis

2016 ◽  
Author(s):  
Simon Nadel ◽  
Johnny Canlas
Keyword(s):  
Central Nervous System ◽  
Clinical Presentation ◽  
The Elderly ◽  
Rational Approach ◽  
Acute Bacterial Meningitis ◽  
High Morbidity ◽  
Central Nervous System Infections ◽  
Neurosurgical Patients ◽  
Haematogenous Spread ◽  
The Brain

Despite advances in antimicrobial therapy, central nervous system infections have a high morbidity and mortality. Most pathogens reach the brain by haematogenous spread following invasion through the mucosal surface of the nasopharynx. The cerebrospinal fluid inflammatory response is responsible for most of the deleterious effects of the infection. Understanding this response has allowed a more rational approach to therapy. Patients may present with non-specific features, especially neonates, infants, post-neurosurgical patients, and the elderly. This chapter will review the epidemiology, pathophysiology, clinical presentation, and diagnosis of acute bacterial meningitis and encephalitis.

scholarly journals Molecular Epidemiology of Enterovirus in Children with Central Nervous System Infections

Viruses ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 100
Author(s):  
Lamprini Posnakoglou ◽  
Elizabeth-Barbara Tatsi ◽  
Panagiota Chatzichristou ◽  
Tania Siahanidou ◽  
Christina Kanaka-Gantenbein ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Molecular Epidemiology ◽  
Seasonal Distribution ◽  
Cns Infection ◽  
Pediatric Hospital ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Epidemiology Data ◽  
Of Greece

Limited recent molecular epidemiology data are available for pediatric Central Nervous System (CNS) infections in Europe. The aim of this study was to investigate the molecular epidemiology of enterovirus (EV) involved in CNS infections in children. Cerebrospinal fluid (CSF) from children (0–16 years) with suspected meningitis–encephalitis (ME) who were hospitalized in the largest pediatric hospital of Greece from October 2017 to September 2020 was initially tested for 14 common pathogens using the multiplex PCR FilmArray® ME Panel (FA-ME). CSF samples positive for EV, as well as pharyngeal swabs and stools of the same children, were further genotyped employing Sanger sequencing. Of the 330 children tested with FA-ME, 75 (22.7%) were positive for EV and 50 different CSF samples were available for genotyping. The median age of children with EV CNS infection was 2 months (IQR: 1–60) and 44/75 (58.7%) of them were male. There was a seasonal distribution of EV CNS infections, with most cases detected between June and September (38/75, 50.7%). EV genotyping was successfully processed in 84/104 samples: CSF (n = 45/50), pharyngeal swabs (n = 15/29) and stools (n = 24/25). Predominant EV genotypes were CV-B5 (16/45, 35.6%), E30 (10/45, 22.2%), E16 (6/45, 13.3%) and E11 (5/45, 11.1%). However, significant phylogenetic differences from previous described isolates were detected. No unusual neurologic manifestations were observed, and all children recovered without obvious acute sequelae. Specific EV circulating genotypes are causing a significant number of pediatric CNS infections. Phylogenetic analysis of these predominant genotypes found genetic differences from already described EV isolates.

scholarly journals Metagenomic Next-generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Central Nervous System infections in HIV-infected patients

2019 ◽  
Author(s):  
Nai qing Zheng ◽  
Pengle Guo ◽  
Xiejie Chen ◽  
Haolan He ◽  
Yueping Li ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Next Generation Sequencing ◽  
Clinical Diagnosis ◽  
Central Nervous System Infection ◽  
Next Generation ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Conventional Methods ◽  
Generation Sequencing

Abstract Background HIV-infected patients have extremely low immunity and various opportunistic infections. Early diagnosis and treatment of these pathogens is critical for patients with HIV infection, especially those with central nervous system (CNS) infections. Metagenomic next generation sequencing (mNGS) has the advantage of identifying a broad range of pathogens and was suggested as a promising tool in the clinical diagnosis for infectious diseases. The clinical application of mNGS in the diagnosis of CNS infections in patients infected with HIV remains inadequately characterized.Methods We retrospectively analyzed data from 22 patients with suspected central nervous system infections who underwent both mNGS and conventional methods including culture, PCR, X-pert/RIF and antigen testing to explored the utility of mNGS in clinical diagnostic microbiology of CNS infections in HIV-infected patients.Results A total of 22 patients participated in the study between June 2018 and May 2019. The consistency of positive percentage of mNGS compared to clinical diagnosis was significantly higher than that of conventional methods (86.36% vs. 45.21%). The proportion of co-infections in mNGS positive samples was significantly higher than that in traditional methods (40.91% vs. 14.39%). Sixteen Extra Pathogens in 14 cases identified by metagenomic NGS only, 6 pathogens affected clinical reasoning and 7 pathogens guided antimicrobial therapy.Conclusions MNGS is a powerful diagnostic method for identifying pathogens in central nervous system infections and provide actionable information in some cases. MNGS technology has positive significance for the diagnosis and clinical treatment of central nervous system infection in HIV-infected patients.

scholarly journals Intrathecal administration of colistin, vancomycin and amikacin for central nervous system infections in ICU neurosurgical patients

Critical Care ◽  
2015 ◽  
Vol 19 (Suppl 1) ◽  
pp. P122
Author(s):  
P Alexandropoulos ◽  
S Georgiou ◽  
V Chantziara ◽  
A Tsimogianni ◽  
E Chinou ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intrathecal Administration ◽  
Central Nervous System Infections ◽  
Neurosurgical Patients

scholarly journals Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
A. Sasidharan ◽  
C. J. Harrison ◽  
D. Banerjee ◽  
R. Selvarangan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Kansas City ◽  
Maximum Temperature ◽  
Cns Infection ◽  
Test Results ◽  
Central Nervous System Infections ◽  
Laboratory Findings ◽  
Cns Infections ◽  
Laboratory Test Results

ABSTRACT Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n = 1/4), followed by detections in 2014 (n = 1/39), 2015 (n = 6/9), and 2016 (n = 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n = 11) were compared with those of select PeV-A3-infected children (n = 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P = 0.017) and fever duration was shorter (P = 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P = 0.014) and absolute lymphocyte (P = 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

scholarly journals HIV Testing in Adults Presenting With Central Nervous System Infections

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Bert Ma ◽  
Karen J Vigil ◽  
Rodrigo Hasbun
Keyword(s):  
Health Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Hiv Testing ◽  
Cns Infection ◽  
Hiv Diagnosis ◽  
Cns Infections ◽  
Hiv Test ◽  
Control And Prevention ◽  
Caucasian Patients

Abstract Background Universal HIV testing in adults presenting to a health care setting was recommended by the Centers for Disease Control and Prevention (CDC) in 2006, but compliance in central nervous system (CNS) infections is unknown. Methods A multicenter study of adults presenting with CNS infections to 18 hospitals in Houston and New Orleans between 2000 and 2015 was done to characterize HIV testing and explore factors associated with a positive HIV test. Results A total of 1478 patients with a diagnosis of meningitis or encephalitis were identified; 180 were excluded because of known HIV diagnosis (n = 100) or were <17 years old (n = 80). Out of 1292 patients, 642 (49.7%) had HIV testing, and testing did not differ significantly before or after the CDC recommendations in 2006 (53% vs 48%; P = .068). An HIV test was more commonly done in patients who were non-Caucasian, had fever >38°C, or had seizures on presentation, and of those tested, non-Caucasian patients and those with photophobia were more likely to have a positive HIV test (P < .05). HIV testing also varied by type of CNS infection: community-acquired bacterial meningitis (98/130, 75.4%), encephalitis (174/255, 68.2%), aseptic meningitis (285/619, 46.0%), and health care–associated meningitis (85/288, 29.5%; P < .001). Conclusions Even though HIV testing should be done in all adults presenting with a CNS infection, testing remains ~50% and did not improve after the recommendation for universal testing by the CDC in 2006.

scholarly journals A metagenomics-based diagnostic approach for central nervous system infections in hospital acute care setting

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohammad Rubayet Hasan ◽  
Sathyavathi Sundararaju ◽  
Patrick Tang ◽  
Kin-Ming Tsui ◽  
Andres Perez Lopez ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Care ◽  
Care Setting ◽  
Diagnostic Approach ◽  
Acute Care Setting ◽  
Central Nervous System Infections

scholarly journals C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS

2016 ◽  
Vol 51 (3) ◽  
pp. 149
Author(s):  
Melawati Olevianingrum ◽  
Yulistiani Yulistiani ◽  
Darto Saharso ◽  
Nun Zairina
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antibiotic Therapy ◽  
Pediatric Patients ◽  
Clinical Laboratory ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Administration ◽  
Central Nervous System Infections ◽  
The Third ◽  
Cns Infections

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.

scholarly journals Escherichia hermannii Infections in Humans: A Systematic Review

2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Petros Ioannou
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Bacterial Infections ◽  
Clinical Presentation ◽  
Distinct Species ◽  
Central Nervous System Infections ◽  
E Coli ◽  
Treatment Data ◽  
Human Infections

Eshcerichia hermannii is a member of the Enterobacteriaceae, first described in 1982 and reclassified as a distinct species in the Escherichia genus after identifying biochemical and genomic differences from E. coli. It is a rare cause of human infections and is supposed to be a co-infector rather than an autonomous cause of infection. The aim of this systematic review was to record and evaluate all available evidence regarding human infections by E. hermannii. A systematic review of PubMed (through 21 December 2018) for studies providing epidemiological, clinical, and microbiological information, as well as treatment data and outcomes of E. hermannii infections was performed. A total of 16 studies, containing data of 17 patients, were eventually included in the analysis. The most common E. hermannii infections were bacteremias, urinary tract, and central nervous system infections. The complication rate, like the occurrence of sepsis, was high. Cephalosporins and aminoglycosides were the most common agents used for treatment. This systematic review describes bacterial infections by E. hermannii and provides information on the epidemiology, clinical presentation, antibiotic resistance, treatment, and outcomes associated with these infections.

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