Accuracy of cerebrospinal fluid ferritin for purulent meningitis

2020 ◽  
pp. archdischild-2019-317960
Author(s):  
Pedro Celiny Ramos Garcia ◽  
Andrea Lucia Machado Barcelos ◽  
Cristian Tedesco Tonial ◽  
Humberto Holmer Fiori ◽  
Paulo Roberto Einloft ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Clinical Symptoms ◽  
Clinical Suspicion ◽  
Purulent Meningitis

ObjectiveTo evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM).MethodWe studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis).ResultsThe median age was 24 (IQR 8–69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0–6.5), 52.9 ng/mL (IQR 30.7–103 ng/mL) and 2.4 ng/mL (IQR 2–4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis.ConclusionCSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.

scholarly journals Value of NSE and S100 Protein of Kawasaki Disease with aseptic meningitis in Infant

2019 ◽  
Vol 14 (1) ◽  
pp. 358-362
Author(s):  
Jiangtao Wang ◽  
Shouhang Chen ◽  
Xiaoling Wang ◽  
Huiru Gu ◽  
Junli Liu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Kawasaki Disease ◽  
Aseptic Meningitis ◽  
Neuronal Damage ◽  
S100 Protein ◽  
Neuron Specific Enolase ◽  
Area Under The Curve ◽  
Control Group ◽  
Purulent Meningitis ◽  
And Control

AbstractThe cerebrospinal fluid content was examined for concentrations of S100 protein and neuron-specific enolase (NSE) in two diseases, Kawasaki disease (KD) with aseptic meningitis (1-3 months) and purulent meningitis (PM), to determine whether or not these measuremets could be used in early diagnosis. The content of cerebrospinal fluid S100 protein of KD with aseptic meningitis and PM were significantly higher than those in the control group. There was also a difference between KD and purulent meningitis (PM). The concentration of NSE was highest in the encephalitis group, which was statistically different from control group. However, there was no difference between the KD and control groups. The levels of S100 protein and NSE of KD with aseptic meningitis were lower than those in PM, indicating that the extent of neuronal damage is significantly lower than of the enchephalitis group. The area under the curve (AUCs) of the receiver operating characteristic (ROC) curve for S100 and NSE were both 0.972. The S100 threshold was 0.4315, the sensitivity was 92.1%, and the specificity was 100%, while the NSE threshold was 9.325, sensitivity 92.1%, and specificity 90%. The combined detection of NSE and S100 levels in the cerebrospinal fluid can be used for the differential diagnosis of KD with aseptic meningitis and purulent meningitis.

scholarly journals Predictive Value of Cerebrospinal Fluid Lactate Level for the Diagnosis of Bacterial Meningitis following Cranial Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 12-18
Author(s):  
Ashok Kharel ◽  
Gopal Sedain ◽  
Sushil krishna Shilpakar ◽  
Mohan Raj Sharma
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Aseptic Meningitis ◽  
Predictive Value ◽  
Lactate Level ◽  
Clinical Suspicion ◽  
Receiver Operating Curve ◽  
Prospective Clinical Study ◽  
Cranial Surgery ◽  
Csf Lactate

Background:To distinguish post-neurosurgical bacterial meningitis (PNBM) from aseptic meningitis is difficult. Inflammatory and biochemical cerebrospinal fluid (CSF) changes mimic those classically observed after CNS surgery. CSF lactate assay has therefore been proposed as a useful PNBM marker. Objective:To determine the value of cerebrospinal fluid (CSF) lactate level for the identification of bacterial meningitis following cranial surgery. Methods:Between January 2016 and December 2016, a prospective clinical study was done in Department of Neurosurgery, in which all patients with clinical suspicion of PNBM were enrolled. Patients with clinical suspicion of bacterial meningitis BM were categorized, according to preset criteria, into 3 groups: (1) proven BM; (2) presumed BM, and (3) nonbacterial meningeal syndrome. CSF markers were plotted in a receiver operating curve (ROC) to evaluate their diagnostic accuracy. Results:The study included 70 patients. We obtained 65 CSF samples from patients with clinical suspicion of BM by CSF analysis. 20 corresponded to proven BM, 7 to probable BM and 38 to excluded BM. Mean lactate in CSF was: 8.4 ±3.0 mmol /l for proven BM, 4.8 ± 0.99 mmol /l for probable BM and 2.08 ± 0.822 mmol/l for excluded BM (P < .001). Conclusion: CSF lactate level has good predictive value to distinguish BM from aseptic meningitis with sensitivity of 90% and specificity: 87% at cut-off value: 4.0 mmol/l.

scholarly journals The cerebrospinal fluid changes and clinical characteristics of aseptic meningitis in Kawasaki disease

2020 ◽  
Author(s):  
Fan Hu ◽  
Xiaoqing Shi ◽  
Yang Fan ◽  
Hanmin Liu ◽  
Kaiyu Zhou
Keyword(s):  
Cerebrospinal Fluid ◽  
Kawasaki Disease ◽  
Aseptic Meningitis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Cervical Lymphadenopathy ◽  
C Reactive Protein ◽  
Neck Stiffness ◽  
Reactive Protein ◽  
Significant Difference

Abstract Background: Aseptic meningitis is not a common feature in Kawasaki disease (KD). However, it could cause difficulty in making correct and in-time diagnosis Methods: We retrospectively investigated patients of KD and bacterial meningitis (BM). Totally 38 KD patients and 126 BM patients were brought into this study. Clinical symptoms, signs and laboratory examinations were compared between the two groups, which included: duration of fever before lumbar puncture, conjunctiva injection, oral cavity change, rash, cervical lymphadenopathy and extremities change, vomiting, front fontanel bulging, neck stiffness, leukocytes, hemoglobin, platelets, C-reactive protein, cerebrospinal fluid examinations, liver function and urinalysis. Results: In clinical signs, vomit and neck stiffness were more prevalent in BM. KD patients showed higher blood leukocyte (p<0.001) and C-reactive protein (p<0.001) in the early febrile stage. Glucose in cerebrospinal fluid of BM patients was significantly lower than KD patients (p=0.003). In ROC curve, the optimal cutoff value of CSF glucose was 2.945mmol/L with the sensitivity of 84.2% and specificity of 71.4%. Pyuria was more prevalent in KD patients (p<0.001). There was no significant difference in front fontanel bulging, hemoglobin, platelet, alanine transaminase, aspartate transaminase, albumin, cerebrospinal fluid leukocytes, cerebrospinal fluid protein and cerebrospinal fluid lactate dehydrogenase. Conclusions ： Full investigation of clinical manifestation and laboratory tests is necessary to distinguish KD with aseptic meningitis and BM. In CSF study, glucose level is more efficient than other items to distinguish these two diseases. Decreased CSF glucose is possibly an indicator of BM rather than KD.

Chapter 10: Diagnosis

2019 ◽  
Author(s):  
Gerhard Dobler
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

• TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from oth-er forms of viral encephalitis or other diseases. • Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. • Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detec-tion of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. • During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. • Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either Infection with other flaviviruses or with other flavivirus vaccines.

Chapter 10: Diagnosis

2020 ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Viral Encephalitis ◽  
Clinical Symptoms ◽  
Serological Tests ◽  
Specific Antibodies ◽  
Cross Reactions ◽  
Neuro Imaging ◽  
Tbev Infection

TBE appears with non-characteristic clinical symptoms, which cannot be distinguished from other forms of viral encephalitis or other diseases. Cerebrospinal fluid and neuro-imaging may give some evidence of TBE, but ultimately cannot confirm the diagnosis. Thus, proving the diagnosis “TBE” necessarily requires confirmation of TBEV-infection by detection of the virus or by demonstration of specific antibodies from serum and/or cerebrospinal fluid. During the phase of clinic symptoms from the CNS, the TBEV can only rarely be detected in the cerebrospinal fluid of patients. Most routinely used serological tests for diagnosing TBE (ELISA, HI, IFA) show cross reactions resulting from either infection with other flaviviruses or with other flavivirus vaccines.

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

2020 ◽  
pp. 1-5
Author(s):  
João Machado Nogueira ◽  
Inês Fonseca ◽  
Marco Duarte
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Symptoms ◽  
Definitive Diagnosis ◽  
Hot Water ◽  
Illustrative Case ◽  
Raising Awareness ◽  
Detailed Medical History ◽  
Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

scholarly journals Colpocephaly Diagnosed in a Neurologically Normal Adult in the Emergency Department

2019 ◽  
Vol 3 (4) ◽  
pp. 421-424
Author(s):  
Christopher Parker ◽  
Wesley Eilbert ◽  
Timothy Meehan ◽  
Christopher Colbert
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Symptoms ◽  
Normal Adult ◽  
Lateral Ventricles ◽  
Asymptomatic Adult ◽  
Neurologically Normal ◽  
Made In

Colpocephaly is a form of congenital ventriculomegaly characterized by enlarged occipital horns of the lateral ventricles with associated neurologic abnormalities. The diagnosis of colpocephaly is typically made in infancy. Its diagnosis in adulthood without associated clinical symptoms is exceptionally rare. We report a case of colpocephaly diagnosed incidentally in an adult without neurologic abnormalities in the emergency department. To our knowledge, this is only the ninth reported case in an asymptomatic adult and the first to be described in the emergency medicine literature.

scholarly journals Ovarian Torsion in a 5-Year Old: A Case Report and Review

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew F. Ryan ◽  
Bobby K. Desai
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Tract ◽  
Clinical Suspicion ◽  
Ovarian Torsion ◽  
Surgical Emergencies ◽  
High Clinical Suspicion ◽  
Tract Infections ◽  
Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum

2014 ◽  
Vol 63 (2) ◽  
pp. 309-312 ◽  
Author(s):  
Georg Härter ◽  
Hagen Frickmann ◽  
Sebastian Zenk ◽  
Dominic Wichmann ◽  
Bettina Ammann ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Real Time ◽  
Real Time Pcr ◽  
Clinical Symptoms ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Antibody Specificity ◽  
Quantitative Real Time Pcr ◽  
Specific Antibodies ◽  
Routine Diagnosis

We describe the case of a 16-year-old German male expatriate from Ghana who presented with obstipation, dysuria, dysaesthesia of the gluteal region and the lower limbs, bilateral plantar hypaesthesia and paraesthesia without pareses. A serum–cerebrospinal fluid (CSF) Schistosoma spp. specific antibody specificity index of 3.1 was considered highly suggestive of intrathecal synthesis of anti-Schistosoma spp. specific antibodies, although standardization of this procedure has not previously been described. Diagnosis was confirmed by detection of Schistosoma DNA in CSF by semi-quantitative real-time PCR at 100-fold concentration compared with serum. Accordingly the two diagnostic procedures, which have not previously been applied for routine diagnosis, appear to be useful for the diagnosis of neuroschistosomiasis. Clinical symptoms resolved following anthelmintic and anti-inflammatory therapy.

Isolation of Parainfluenza Virus Type 3 from Cerebrospinal Fluid Associated with Aseptic Meningitis

1993 ◽  
Vol 99 (6) ◽  
pp. 705-707 ◽  
Author(s):  
Randall D. Craver ◽  
Robert S. Gohd ◽  
Daniel R. Sundin ◽  
John C. Hierholzer
Keyword(s):  
Cerebrospinal Fluid ◽  
Aseptic Meningitis ◽  
Virus Type ◽  
Parainfluenza Virus ◽  
Type 3
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