Meningitis Due to Mumps Virus in a Child with Acute Leukemia

PEDIATRICS ◽  
1970 ◽  
Vol 46 (6) ◽  
pp. 942-945
Author(s):  
Lothar M.T. Rupprecht ◽  
J. Lawrence Naiman
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Virus Infection ◽  
Acute Leukemia ◽  
Cell Count ◽  
Mononuclear Cell ◽  
Viral Meningitis ◽  
Mumps Virus ◽  
Leukemic Infiltration ◽  
Cerebrospinal Fluid Examination

An 8½-year-old boy with leukemia in remission developed a meningitis-like syndrome associated with increased mononuclear cell count in the cerebrospinal fluid. Examination of the stained CSF sediment showed these to be small lymphocytes rather than lymphoblasts, suggesting a diagnosis of viral meningitis rather than leukemic infiltration of the meninges. Serologic studies gave evidence of a recent mumps virus infection. Viral meningitis should not be overlooked in the differential diagnosis of meningeal reactions in children with leukemia.

scholarly journals Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Leonardo Silva de Araujo ◽  
Kevin Pessler ◽  
Kurt-Wolfram Sühs ◽  
Natalia Novoselova ◽  
Frank Klawonn ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cell Count ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Viral Meningitis ◽  
Acute Bacterial Meningitis ◽  
Membrane Phospholipids ◽  
Cns Disorders

Abstract Background The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell’s palsy, Tourette syndrome, normal pressure hydrocephalus). Results PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman’s ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. Conclusions Increased CSF PC ae C44:6 concentrations in bacterial meningitis likely reflect ongoing CNS cell membrane stress or damage and have potential as additional, sensitive biomarker to diagnose bacterial meningitis in patients with less pronounced neuroinflammation.

scholarly journals Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics

2019 ◽  
Vol 29 (3) ◽  
pp. 244-254 ◽  
Author(s):  
Sérgio Monteiro de Almeida ◽  
Suélen Maria Parizotto Furlan ◽  
Arianne Maris Munhoz Cretella ◽  
Bruna Lapinski ◽  
Keite Nogueira ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Positive Likelihood Ratio ◽  
Viral Meningitis ◽  
Acute Bacterial Meningitis ◽  
Blood Levels ◽  
Csf Biomarkers ◽  
Control Groups ◽  
Easy Method ◽  
Csf Lactate

Objective: Several cerebrospinal fluid (CSF) biomarkers are used to distinguish between acute bacterial meningitis (BM) and viral meningitis (VM). We compared the ability of lactate and glucose (GL) in CSF and the CSF/blood GL ratio to distinguish between acute BM and VM with typical and atypical CSF characteristics. Methods: Three hundred and twenty-four CSF reports were included, which were distributed as the acute BM, VM, and normal control groups (n = 63, 139, and 122, respectively). Results: Lactate level in the CSF of acute BM group was 4-fold higher than that in the acute VM and control groups (p < 0.0001). CSF lactate presented higher specificity (92%) and negative predictive value (94%) compared to CSF GL and CSF/blood GL ratio in distinguishing acute BM and VM. Definitive acute BM or VM with atypical CSF cell characteristics was observed in 23.2 and 21.6% of samples, respectively, and these groups showed reduced performance of characteristics of all CSF biomarkers. CSF lactate showed better operational characteristics than those of CSF GL and CSF/blood GL ratio, presenting the highest positive likelihood ratio, and thus aided in the differential diagnosis of VM with atypical CSF. Conclusion: The CSF lactate assay can be routinely used in laboratories as a rapid, automated, and easy method that is independent of lactate blood levels.

scholarly journals Identification of Cerebrospinal Fluid Metabolites as Biomarkers for Enterovirus Meningitis

2019 ◽  
Vol 20 (2) ◽  
pp. 337 ◽  
Author(s):  
Dominica Ratuszny ◽  
Kurt-Wolfram Sühs ◽  
Natalia Novoselova ◽  
Maike Kuhn ◽  
Volkhard Kaever ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Normal Pressure ◽  
Viral Meningitis ◽  
Metabolic Reprogramming ◽  
Diagnostic Tools ◽  
Csf Biomarkers ◽  
Metabolite Profiles ◽  
Enteroviral Meningitis ◽  
Combined Classifier

Enteroviruses are among the most common causes of viral meningitis. Enteroviral meningitis continues to represent diagnostic challenges, as cerebrospinal fluid (CSF) cell numbers (a well validated diagnostic screening tool) may be normal in up to 15% of patients. We aimed to identify potential CSF biomarkers for enteroviral meningitis, particularly for cases with normal CSF cell count. Using targeted liquid chromatography-mass spectrometry, we determined metabolite profiles from patients with enteroviral meningitis (n = 10), and subdivided them into those with elevated (n = 5) and normal (n = 5) CSF leukocyte counts. Non-inflamed CSF samples from patients with Bell’s palsy and normal pressure hydrocephalus (n = 19) were used as controls. Analysis of 91 metabolites revealed considerable metabolic reprogramming in the meningitis samples. It identified phosphatidylcholine PC.ae.C36.3, asparagine, and glycine as an accurate (AUC, 0.92) combined classifier for enterovirus meningitis overall, and kynurenine as a perfect biomarker for enteroviral meningitis with an increased CSF cell count (AUC, 1.0). Remarkably, PC.ae.C36.3 alone emerged as a single accurate (AUC, 0.87) biomarker for enteroviral meningitis with normal cell count, and a combined classifier comprising PC.ae.C36.3, PC.ae.C36.5, and PC.ae.C38.5 achieved nearly perfect classification (AUC, 0.99). Taken together, this analysis reveals the potential of CSF metabolites as additional diagnostic tools for enteroviral meningitis, and likely other Central nervous system (CNS) infections.

Recommendations for cerebrospinal fluid examination in acute leukemia

2017 ◽  
Vol 75 (5) ◽  
pp. 503-512
Author(s):  
Sandrine Girard ◽  
Odile Fenneteau ◽  
Fanélie Mestrallet ◽  
Xavier Troussard ◽  
Jean-François Lesesve
Keyword(s):  
Cerebrospinal Fluid ◽  
Acute Leukemia ◽  
Cerebrospinal Fluid Examination

scholarly journals Nested PCR for Rapid Detection of Mumps Virus in Cerebrospinal Fluid from Patients with Neurological Diseases

2000 ◽  
Vol 38 (1) ◽  
pp. 274-278
Author(s):  
Gustavo Palacios Poggio ◽  
Claudia Rodriguez ◽  
Daniel Cisterna ◽  
María Cecilia Freire ◽  
Jerónimo Cello
Keyword(s):  
Cerebrospinal Fluid ◽  
Virus Infection ◽  
Clinical Diagnosis ◽  
Vaccine Coverage ◽  
Mumps Virus ◽  
Immunoglobulin M ◽  
Cns Infection ◽  
Cns Disease ◽  
Cns Infections ◽  
Virus Rna

ABSTRACT In this study, we have developed a reverse transcription (RT)-nested polymerase chain reaction (n-PCR) for the detection of mumps virus RNA in cerebrospinal fluid (CSF) from patients with neurological infections. A specific 112-bp fragment was amplified by this method with primers from the nucleoprotein of the mumps virus genome. The mumps virus RT–n-PCR was capable of detecting 0.001 PFU/ml and 0.005 50% tissue culture infective dose/ml. This method was found to be specific, since no PCR product was detected in each of the CSF samples from patients with proven non-mumps virus-related meningitis or encephalitis. Mumps virus RNA was detected in all 18 CSF samples confirmed by culture to be infected with mumps virus. Positive PCR results were obtained for the CSF of 26 of 28 patients that were positive for signs of mumps virus infection (i.e., cultivable virus from urine or oropharyngeal samples or positivity for anti-mumps virus immunoglobulin M) but without cultivable virus in their CSF. Overall, mumps virus RNA was detected in CSF of 96% of the patients with a clinical diagnosis of viral central nervous system (CNS) disease and confirmed mumps virus infection, while mumps virus was isolated in CSF of only 39% of the patients. Furthermore, in a retrospective study, we were able to detect mumps virus RNA in 25 of 55 (46%) CSF samples from patients with a clinical diagnosis of viral CNS disease and negative laboratory evidence of viral infection including mumps virus infection. The 25 patients represent 12% of the 236 patients who had a clinical diagnosis of viral CNS infections and whose CSF was examined at our laboratory for a 2-year period. The findings confirm the importance of mumps virus as a causative agent of CNS infections in countries with low vaccine coverage rates. In summary, our study demonstrates the usefulness of the mumps virus RT–n-PCR for the diagnosis of mumps virus CNS disease and suggests that this assay may soon become the “gold standard” test for the diagnosis of mumps virus CNS infection.

scholarly journals A Seasonal Cause of Encephalitis: Influenza Virus A (H3N1) Infection

2021 ◽  
Author(s):  
Rúben Reis ◽  
Francisco Adragão ◽  
Catarina Parente ◽  
Inês Nunes ◽  
Armindo Ramos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cerebrospinal Fluid ◽  
Influenza Virus ◽  
Differential Diagnosis ◽  
Virus Infection ◽  
Influenza Virus Infection ◽  
Altered Mental Status ◽  
Influenza Virus A ◽  
Life Threatening ◽  
History Of

Influenza virus infection can have a range of presentations, from asymptomatic to life-threatening disease. We present the case of a 57-year-old woman with a known history of schizophrenia (controlled with medication) who presented to our emergency department in a coma after experiencing a seizure. She had reported flu-like symptoms in the previous week, which evolved to dyspnoea and altered mental status culminating in seizures and coma. Influenza virus A (H3N1) was identified in the cerebrospinal fluid. Although a rare cause of encephalitis, the influenza virus should be considered in the differential diagnosis, especially during epidemics.

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