Neonatal Ureaplasma parvum meningitis complicated with subdural hematoma: a case report and literature review

Abstract Background Neonatal meningitis is a severe infectious disease of the central nervous system with high morbidity and mortality. Ureaplasma parvum is extremely rare in neonatal central nervous system infection. Case presentation We herein report a case of U. parvum meningitis in a full-term neonate who presented with fever and seizure complicated with subdural hematoma. After hematoma evacuation, the seizure disappeared, though the fever remained. Cerebrospinal fluid (CSF) analysis showed inflammation with CSF pleocytosis (1135–1319 leukocytes/μl, mainly lymphocytes), elevated CSF protein levels (1.36–2.259 g/l) and decreased CSF glucose (0.45–1.21 mmol/l). However, no bacterial or viral pathogens in either CSF or blood were detected by routine culture or serology. Additionally, PCR for enteroviruses and herpes simplex virus was negative. Furthermore, the CSF findings did not improve with empirical antibiotics, and the baby experienced repeated fever. Thus, we performed metagenomic next-generation sequencing (mNGS) to identify the etiology of the infection. U. parvum was identified by mNGS in CSF samples and confirmed by culture incubation on mycoplasma identification medium. The patient’s condition improved after treatment with erythromycin for approximately 5 weeks. Conclusions Considering the difficulty of etiological diagnosis in neonatal U. parvum meningitis, mNGS might offer a new strategy for diagnosing neurological infections.

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Partial Status Epilepticus with Paradoxical Protein-Cytologic Dissociation in Cerebrospinal Fluid

International Journal of Epilepsy ◽

10.1055/s-0040-1716432 ◽

2020 ◽

Author(s):

Neeraj Singh ◽

John J. Lansing ◽

Aparna Polavarapu

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Status Epilepticus ◽

Central Nervous System Infection ◽

Case Series ◽

Refractory Status Epilepticus ◽

Multiple Drug ◽

High Morbidity ◽

Drug Interventions

AbstractStatus epilepticus is associated with high morbidity and mortality, often requiring multiple drug interventions and intensive care monitoring. Etiology of status epilepticus plays a crucial role in the treatment, natural course and outcome of the patient, prompting extensive testing and imaging. For example, an important risk for status epilepticus in adults and children is the presence of an underlying viral or bacterial central nervous system infection, appropriate treatment of which can improve the outcome of the patient. We present three cases of new-onset refractory status epilepticus in women who did not have evidence of a central nervous system infection and had significantly elevated leukocytes compared to protein in the cerebrospinal fluid. This finding suggests an autoimmune etiology; however, standard autoimmune testing was unremarkable in all cases. This case series highlights the variability in presentation and clinical course in patients presenting with status epilepticus of unknown cause, and we discuss the importance of further research into appropriate and reliable diagnostic evaluations.

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Characteristics and biomarkers of patients with central nervous system infection admitted to a referral hospital in Northern Vietnam

Tropical Medicine and Health ◽

10.1186/s41182-021-00322-2 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Cuong Chi Ngo ◽

Shungo Katoh ◽

Futoshi Hasebe ◽

Bhim Gopal Dhoubhadel ◽

Tomoko Hiraoka ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Bacterial Meningitis ◽

Central Nervous System Infection ◽

Cns Infection ◽

High Morbidity ◽

Tubercular Meningitis ◽

Viral Pathogens ◽

Number Of Patients ◽

Csf Findings

Abstract Background Laboratory facilities for etiological diagnosis of central nervous system (CNS) infection are limited in developing countries; therefore, patients are treated empirically, and the epidemiology of the pathogens is not well-known. Tubercular meningitis is one of the common causes of meningitis, which has high morbidity and mortality, but lacks sensitive diagnostic assays. The objectives of this study were to determine the causes of meningitis in adult patients by using molecular assays, to assess the risk factors associated with them, and to explore whether biomarkers can differentiate tubercular meningitis from bacterial meningitis. Methods We conducted a cross-sectional study in the Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, from June 2012 to May 2014. All patients who were ≥ 16 years old and who had meningoencephalitis suggested by abnormal cerebrospinal fluid (CSF) findings (CSF total cell >5/mm3 or CSF protein ≥40 mg/dL) were included in the study. In addition to culture, CSF samples were tested for common bacterial and viral pathogens by polymerase chain reaction (PCR) and for biomarkers: C-reactive protein and adenosine deaminase (ADA). Results Total number of patients admitted to the department was 7506; among them, 679 were suspected to have CNS infection, and they underwent lumbar puncture. Five hundred eighty-three patients had abnormal CSF findings (meningoencephalitis); median age was 45 (IQR 31–58), 62.6% were male, and 60.9% were tested for HIV infection. Among 408 CSF samples tested by PCR, out of them, 358 were also tested by culture; an etiology was identified in 27.5% (n=112). S. suis (8.8%), N. meningitis (3.2%), and S. pneumoniae (2.7%) were common bacterial and HSV (2.2%), Echovirus 6 (0.7%), and Echovirus 30 (0.7%) were common viral pathogens detected. M. tuberculosis was found in 3.2%. Mixed pathogens were detected in 1.8% of the CSF samples. Rural residence (aOR 4.1, 95% CI 1.2–14.4) and raised CSF ADA (≥10 IU/L) (aOR 25.5, 95% CI 3.1–212) were associated with bacterial meningitis when compared with viral meningitis; similarly, raised CSF ADA (≥10 IU/L) (aOR 42.2, 95% CI 2.0–882) was associated with tubercular meningitis. Conclusions Addition of molecular method to the conventional culture had enhanced the identification of etiologies of CNS infection. Raised CSF ADA (≥10 IU/L) was strongly associated with bacterial and tubercular meningitis. This biomarker might be helpful to diagnose tubercular meningitis once bacterial meningitis is ruled out by other methods.

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How and when to use CSF to investigate neonates and children with possible central nervous system infection

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-321242 ◽

2021 ◽

pp. edpract-2020-321242

Author(s):

Gemma Winzor ◽

Sowsan F Atabani

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Diagnostic Testing ◽

Central Nervous System Infection ◽

Oral Intake ◽

Current Evidence ◽

Cns Infection ◽

Optimal Timing ◽

Biochemical Tests ◽

Csf Analysis

A child presented to the emergency department with fever, reduced consciousness, irritability and reduced oral intake. Infective meningitis and encephalitis were within the differential diagnoses. Is a lumbar puncture (LP) indicated and, if so, what is the optimal timing of LP? Will antimicrobial pretreatment affect the cerebrospinal fluid (CSF) results? How can clinicians optimise diagnostic stewardship to benefit individual patients and society at large? Interpretation of rapidly available CSF biochemical tests (protein, glucose and lactate levels) and microscopy can provide a prompt insight into the infective aetiology and inform treatment and further diagnostic testing strategies. Diagnosis of an aetiological pathogen in a patient presenting with central nervous system (CNS) infection has clinical, infection control and public health implications. A plethora of tests are available to enable CSF analysis in patients with possible CNS infection. We aimed to summarise current evidence and guidance to ensure the best possible use of the diagnostics available.

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Ureaplasma parvum meningitis following atypical choroid plexus papilloma resection in an adult patient: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-021-06975-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Na Xing ◽

Zhenxiang Zhao ◽

Qingjing Li ◽

Yalan Dong ◽

Jianfeng Li ◽

...

Keyword(s):

Adult Patient ◽

Choroid Plexus Papilloma ◽

Simultaneous Detection ◽

Perinatal Complications ◽

Ureaplasma Parvum ◽

Protein Levels ◽

Csf Analysis ◽

Invasive Infections ◽

Empirical Antibiotics ◽

Atypical Presentations

Abstract Background While Ureaplasma parvum has previously been linked to the incidence of chorioamnionitis, abortion, premature birth, and perinatal complications, there have only been rare reports of invasive infections of the central nervous system (CNS) in adults. Owing to its atypical presentation and the fact that it will yield sterile cultures using conventional techniques, diagnosing U. parvum meningitis can be challenging. Case presentation We describe a case of U. parvum meningitis detected in an adult patient following surgical brain tumor ablation. After operation, the patient experienced epilepsy, meningeal irritation, and fever with unconsciousness. Cerebrospinal fluid (CSF) analysis showed leukocytosis (484 * 106 /L), elevated protein levels (1.92 g/L), and decreased glucose concentrations (0.02 mmol/L). Evidence suggested that the patient was suffering from bacterial meningitis. However, no bacterial pathogens in either CSF or blood were detected by routine culture or serology. The symptoms did not improve with empirical antibiotics. Therefore, we performed metagenomic next-generation sequencing (mNGS) to identify the etiology of the meningitis. Ureaplasma parvum was detected by mNGS in CSF samples. To the best of our knowledge, this case is the first reported instance of U. parvum meningitis in an adult patient in Asian. After diagnosis, the patient underwent successful moxifloxacin treatment and recovered without complications. Conclusions As mNGS strategies can enable the simultaneous detection of a diverse array of microbes in a single analysis, they may represent a valuable means of diagnosing the pathogens responsible for CNS infections and other clinical conditions with atypical presentations.

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Perinatal listeriosis patients at a maternity hospital in Beijing, China

10.21203/rs.3.rs-18011/v1 ◽

2020 ◽

Author(s):

Chunyun Li ◽

Huihui Zeng ◽

Xin Ding ◽

Yi Chen ◽

Xiaowei Liu ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Infection ◽

Clinical Manifestations ◽

Maternity Hospital ◽

High Morbidity ◽

Care Hospital ◽

Perinatal Complications ◽

Adverse Pregnancy ◽

Beijing China

Abstract Background: Listeriosis is a rare but severe emerging foodborne infectious disease. Perinatal listeriosis is extremely prone to causing septicaemia and CNS (central nervous system) infection, and serious adverse pregnancy outcomes (abortion and neonate death). This research reports perinatal listeriosis cases at a maternity hospital over the course of six years in Beijing, China.Methods: Beijing Obstetrics and Gynecology Hospital (BOGH) is the largest maternal and child health care hospital in China. We retrospectively searched all the laboratory confirmed 12 pregnancy-associated listeriosis cases during Jan 1, 2013 to Dec 31, 2018. The clinical manifestations, laboratory results, perinatal complications and outcomes were investigated.Results: In BOGH, 12 perinatal listeriosis cases were diagnosed based on Listeria positive culture, including 10 single pregnancies and 2 twin pregnancies, and the incidence of which is 13.7/100,000 deliveries (12/87,644). Among those cases, four pregnant women and four newborns had septicaemia, and two of the neonatal septicaemia also got CNS (central nervous system) infection. All the maternal patients recovered. For the fourteen offsprings, there were 8 newborns and 6 aborted fetuses, with two newborns died and 6 survived among the 8 newborns, and none of survivors had sequelae. The feto-neonatal fatality ratio is 57.1% (8/14).Conclusions: Perinatal listeriosis is associated with high morbidity and mortality. It has been confirmed that many factors contribute to the high mortality, such as high proportion of second trimester onset, empiric antibiotics with low pathogenic bacterium effective coverage.

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An unusual presentation of encephalitis which mimicked generalised tetanus

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20212499 ◽

2021 ◽

Vol 8 (7) ◽

pp. 1319

Author(s):

Anushree M. Benny ◽

Rajendra Prasad Nagar ◽

Gautam Lal Nagori

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Movement Disorders ◽

Viral Encephalitis ◽

Central Nervous System Infection ◽

Muscle Spasm ◽

Temporal Lobes ◽

Csf Analysis ◽

Intravenous Acyclovir ◽

New Onset

Movement disorders are frequent mimickers of more severe neurological presentations, whenever it is diagnosed one should suspect a central nervous system infection as an underlying cause. A 11 year old girl presented in casuality with intermittent generalised muscle spasm, clear sensorium, trismus and risus sardonicus. Initially managed as a case of tetanus, rapid resolution of spasms made suspicion of encephalitis as underlying cause of dystonia which mimicked tetanus. Blood investigation and CSF analysis were normal. CECT brain showed hyper dense lesions bilateral temporal lobes suggestive of viral encephalitis. Child was managed with intravenous acyclovir and dexamethasone after which child improved considerably. Acute dystonia is a close mimicker of tetanus. Any patient presenting with new onset movement disorder should be investigated for central nervous system infection even though it has been reported as a rare cause for the same.

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