scholarly journals Microbial aspects and potential markers for differentiation between bacterial and viral meningitis among adult patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251518
Author(s):  
Sultan F. Alnomasy ◽  
Bader S. Alotaibi ◽  
Ahmed H. Mujamammi ◽  
Elham A. Hassan ◽  
Mohamed E. Ali
Keyword(s):  
Bacterial Meningitis ◽  
Leucocyte Count ◽  
Predictive Accuracy ◽  
Viral Meningitis ◽  
Adult Patients ◽  
Medical Emergency ◽  
Varicella Zoster ◽  
Glucose Levels ◽  
Neisseria Meningitides ◽  
Acute Meningitis

Objectives Meningitis is a medical emergency with permanent disabilities and high mortality worldwide. We aimed to determine causative microorganisms and potential markers for differentiation between bacterial and viral meningitis. Methodology Adult patients with acute meningitis were subjected to lumber puncture. Cerebrospinal fluid (CSF) microorganisms were identified using Real-time PCR. PCT and CRP levels, peripheral and CSF-leucocyte count, CSF-protein and CSF-glucose levels were assessed. Results Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Neisseria meningitides was the most frequent bacteria and varicella-zoster virus was the most common virus. Using ROC analyses, serum PCT and CSF-parameters can discriminate bacterial from viral meningitis. Combined ROC analyses of PCT and CSF-protein significantly improved the effectiveness in predicting bacterial meningitis (AUC of 0.998, 100%sensitivity and 97.1%specificity) than each parameter alone (AUC of 0.951 for PCT and 0.996 for CSF-protein). Conclusion CSF-protein and serum PCT are considered as potential markers for differentiating bacterial from viral meningitis and their combination improved their predictive accuracy to bacterial meningitis.

scholarly journals Incidence, epidemiology and etiology of acute meningitis in Mures County – an observational study

2012 ◽  
Vol 18 (3) ◽  
pp. 116-125 ◽  
Author(s):  
Brindusa Tilea ◽  
Klara Brînzaniuc ◽  
I. Tilea
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Meningitis ◽  
Rural Areas ◽  
Viral Meningitis ◽  
Latex Agglutination ◽  
Etiologic Agent ◽  
Resistance Testing ◽  
Varicella Zoster ◽  
Acute Meningitis ◽  
The Mean

Abstract Background: Meningitis are multiple aetiology disorders characterized by infectious triggered inflammation of the meningeal serrosa manifesting as an acute systemic illness with variable evolution from cure to death. The objectives of this study were the evaluation of incidence, epidemiologic and diagnostic aspects of the acute meningitis in a well define region. Methods: we have designed an observational retrospective study that included a number of 165 consecutively admitted patients with the diagnosis of meningitis at the Targu-Mures Infectious Disease Clinic, Romania, from January 1st to December 31st 2011. We have compared cases of confirmed meningitis vs. meningismus, and meningeal reaction. We kept track of the demographic aspects, the annual and seasonal distribution of cases. The diagnosis of meningitis was established by examination of the cerebrospinal fluid such as: aspect, pleocytosis, biochemical reactions, wet mounts, Latex agglutination tests, serological reactions, cultures and antibiotic resistance testing (when needed). Results: the majority of the patients were male, from rural areas. The mean age of patients with bacterimeningitis was 36 years old, and that of viral meningitis cases was 20 years old. The acute meningitis incidence in 2011 was 19.73 cases/100.000 inhabitants. 26 patients (15.76%) of the observed group were diagnosed with bacterial meningitis, and 63 cases (38.18%) with viral meningitis. The most common cause for bacterial meningitis were Gram-positive cocci, and for viral meningitis, the varicella-zoster virus. Conclusions: in 2011, the incidence of acute meningitis in our region has not decreased significantly compared to previous studies. In the case of bacterial meningitis, the etiologic agent was identified in a small proportion, possibly because of antibiotic treatment administered before the admission, also observing an increase in antibiotic resistance of the identified agents.

scholarly journals 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S510-S511
Author(s):  
Kittipat Aimbudlop ◽  
Sasisopin Kiertiburanakul
Keyword(s):  
Bacterial Meningitis ◽  
Hiv Infection ◽  
White Blood Cells ◽  
Clinical Manifestations ◽  
Hospital Setting ◽  
Polymorphonuclear Neutrophils ◽  
Medical Emergency ◽  
Acute Bacterial Meningitis ◽  
Clinical Presentations ◽  
Acute Meningitis

Abstract Background Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis. Methods A retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed. Results A total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm3 increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm3 increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%. Conclusion In this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy. Disclosures All authors: No reported disclosures.

scholarly journals Identifying Low-risk Patients for Bacterial Meningitis in Adult Patients with Acute Meningitis

2009 ◽  
Vol 48 (7) ◽  
pp. 537-543 ◽  
Author(s):  
Yasuharu Tokuda ◽  
Masahiro Koizumi ◽  
Gerald H. Stein ◽  
Richard B. Birrer
Keyword(s):  
Bacterial Meningitis ◽  
Low Risk ◽  
Adult Patients ◽  
Acute Meningitis ◽  
Risk Patients

scholarly journals Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

2021 ◽  
Vol 11 (3-S) ◽  
pp. 53-60
Author(s):  
Suhail Al Shammri ◽  
Arpita Chattopadhyay ◽  
Geeti Chadha ◽  
Ahmed Zayada ◽  
Faisal Al Shaifan ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Positive Culture ◽  
Viral Meningitis ◽  
Antimicrobial Treatment ◽  
Clinical Suspicion ◽  
Adult Patients ◽  
Diagnostic Challenge ◽  
Neisseria Meningitides

Introduction: High mortality rate of meningitis has been reported in Kuwait, however, limited data is available describing this disease in adult patients. With this background, we conducted a prospective study on patients admitted with meningitis, with an objective to describe the risk factors, clinical presentation, disease course and outcome; focus given on diagnostic problems and consequent management difficulties. Methods: Our team diagnosed, managed and documented hospital records of patients (n=44) admitted with suspected meningitis at a referral hospital during 2010-12. Detailed information was collected regarding clinical presentation, CSF analysis, treatment, hospital course and outcome as per Glasgow Outcome Scale (GOS). Results: Bacterial, viral, and tuberculosis (TB) meningitis were seen in 22.8%, 52.3%, and 15.9% of patients. Clinical features of our cohort were consistent with available literature. Positive identification of organism by culture, gram stain, or antigen test was possible in only 6 patients i.e. Streptococcus pneumonae-(n=3), Streptococcus agalactiae-(n=2), Neisseria meningitides-(n=1). CSF polymerase chain reaction was detected positive for Enterovirus RNA, and Herpes simplex virus DNA for one patient each. Empirical antimicrobial treatment directed against common causative organisms was the mainstay of management of bacterial meningitis. Viral meningitis was managed symptomatically. TB meningitis patients were administered anti-tubercular treatment. As per GOS, 38(85.4%) patients recovered with no neurological deficit. Six patients recovered with mild to moderate deficit. Conclusion: Low positive culture rates and inability to identify pathogens have been a diagnostic challenge faced by our team. Strong clinical suspicion, early empiric antibiotic and dexamethasone therapy perhaps contributed to very good recovery in our study. Keywords: Meningitis, Kuwait, Clinical Suspicion, Antibiotic, Dexamethasone

Neurotrophin-3 Levels in Cerebrospinal Fluid From Children With Bacterial Meningitis, Viral Meningitis, or Encephalitis

2000 ◽  
Vol 15 (1) ◽  
pp. 19-21 ◽  
Author(s):  
Yumi Mizuno ◽  
Hidetoshi Takada ◽  
Kyoko Urakami ◽  
Kenji Ihara ◽  
Ryutaro Kira ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Viral Meningitis ◽  
Neurotrophin 3

Pharmacokinetics of Propofol in Adult Patients Undergoing Coronary Revascularization

1996 ◽  
Vol 84 (6) ◽  
pp. 1288-1297 ◽  
Author(s):  
James M. Bailey ◽  
Christina T. Mora ◽  
Stephen L. Shafer ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cross Validation ◽  
Predictive Accuracy ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Adult Patients ◽  
Pharmacokinetic Parameters ◽  
Surgery Patient ◽  
Prospective Comparison

Background Propofol is increasingly used for cardiac anesthesia and for perioperative sedation. Because pharmacokinetic parameters vary among distinct patient populations, rational drug dosing in the cardiac surgery patient is dependent on characterization of the drug's pharmacokinetic parameters in patients actually undergoing cardiac procedures and cardiopulmonary bypass (CPB). In this study, the pharmacokinetics of propofol was characterized in adult patients undergoing coronary revascularization. Methods Anesthesia was induced and maintained by computer-controlled infusions of propofol and alfentanil, or sufentanil, in 41 adult patients undergoing coronary artery bypass graft surgery. Blood samples for determination of plasma propofol concentrations were collected during the predefined study periods and assayed by high-pressure liquid chromatography. Three-compartment model pharmacokinetic parameters were determined by nonlinear extended least-squares regression of pooled data from patients receiving propofol throughout the perioperative period. The effect of CPB on propofol pharmacokinetics was modeled by allowing the parameters to change with the institution and completion of extracorporeal circulation and selecting the optimal model on the basis of the logarithm of the likelihood. Predicted propofol concentrations were calculated by convolving the infusion rates with unit disposition functions using the estimated parameters. The predictive accuracy of the parameters was evaluated by cross-validation and by a prospective comparison of predicted and measured levels in a subset of patients. Results Optimal pharmacokinetic parameters were: central compartment volume = 6.0 l; second compartment volume = 49.5 l; third compartment volume = 429.3 l; Cl1 (elimination clearance) = 0.68 l/min; Cl2 (distribution clearance) = 1.97 l/min1; and Cl3 (distribution clearance) = 0.70 l/min. The effects of CPB were optimally modeled by step changes in V1 and Cl1 to values of 15.9 and 1.95, respectively, with the institution of CPB. Median absolute prediction error was 18% in the cross-validation assessment and 19% in the prospective evaluation. There was no evidence for nonlinear kinetics. Previously published propofol pharmacokinetic parameter sets poorly predicted the observed concentrations in cardiac surgical patients. Conclusions The pharmacokinetics of propofol in adult patients undergoing cardiac surgery with CPB are dissimilar from those reported for other adult patient populations. The effect of CPB was best modeled by an increase in V1 and Cl1. Predictive accuracy of the derived pharmacokinetic parameters was excellent as measured by cross-validation and a prospective test.

Varicella-Zoster Viral Meningitis Mimicking Lymphoma

2003 ◽  
Vol 44 (10) ◽  
pp. 1793-1795 ◽  
Author(s):  
S. Park ◽  
V. Leymarie ◽  
F. Agbalika ◽  
L. Galicier ◽  
E. Oksenhendler ◽  
...  
Keyword(s):  
Viral Meningitis ◽  
Varicella Zoster

scholarly journals Meningoencephalitis in intensive care unit: Do Japanese Encephalitis cases go unsuspected?

2017 ◽  
Vol 7 (1) ◽  
pp. 7-10
Author(s):  
Ashish Ghimire ◽  
Balkrishna Bhattarai ◽  
Basudha Khanal ◽  
Suchana Marhatta ◽  
Gopendra Prasad Deo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adult Patients ◽  
Medical Emergency ◽  
Real Problem ◽  
Cerebrospinal Fluid Analysis ◽  
Laboratory Findings ◽  
Fluid Analysis ◽  
Intensive Approach ◽  
Serology Testing

Background: Meningoencephalitis (ME) is a medical emergency. Acute infective encephalitis is usually viral. Nepal has the second highest prevalence of JE in South East Asia. About one third of the JE cases results in death. The records of the JE in the laboratory of B.P. Koirala Institute of Health Sciences (BPKIHS) showed 760 samples to have the evidence of JE infection out of 3352 tested during the period of 2001-2011 AD. The present study aimed to conduct an audit on meningoencephalitis cases admitted in the ICU of our hospital in an attempt to find its burden.Methods: Medical records of all the adult patients with the provisional diagnosis of Meningoencephalitis at BPKIHS over the period of 2009-2011 AD were examined. Laboratory findings of all the patients diagnosed with ME who were admitted to the eight bedded general intensive care unit (ICU) were also reviewed. The diagnosis was made based on the findings of medical history, clinical examination and cerebrospinal fluid analysis for biochemistry and cytology, results of anti JE IgM test performed on CSF and/or serum.Results: Altogether 127 samples of CSF were obtained from adult patients admitted in different inpatient department of BPKIHS with the clinical diagnosis of meningo encephalitis between 2009-2011 AD. Out of them, 25 (19.68%) were tested positive of JE. A total of 684 patients were admitted over the same period with different diagnoses in 8 bedded ICU of hospital. Fifteen (2.19%) were transferred to the ICU with the ME. In the ICU, 9(60%) were treated as viral encephalitis. Among them CSF of only 4 patients’ were sent for testing for JE and found positive in 2 cases. Seven (46.6%) patients expired while 4(26.6%) were taken home by the relatives against medical advice in critically ill conditions and remaining 4 (26.6%) improved and transferred to ward. Among the expired patients 5 (71.4%) had viral encephalitis.Conclusion: JE is a real problem but many cases are likely to have been gone undetected. Adoption of a more intensive approach with much liberal serology testing policy seems to be appropriate for better detecting JE cases in the setting.

Childhood meningitis in the conjugate vaccine era: a prospective cohort study

2014 ◽  
Vol 100 (3) ◽  
pp. 292-294 ◽  
Author(s):  
Manish Sadarangani ◽  
Louise Willis ◽  
Seilesh Kadambari ◽  
Stuart Gormley ◽  
Zoe Young ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Group B Streptococcus ◽  
Bacterial Pathogen ◽  
Antibiotic Use ◽  
Viral Meningitis ◽  
Older Children ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Reactive Protein ◽  
Group B

Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis—13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.

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