Can Seizures Be the Sole Manifestation of Meningitis in Febrile Children?

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. 527-534
Author(s):  
Steven M. Green ◽  
Steven G. Rothrock ◽  
Kathleen J. Clem ◽  
Raymond F. Zurcher ◽  
Laura Mellick
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Decision Rules ◽  
Case Series ◽  
Signs And Symptoms ◽  
Viral Meningitis ◽  
Retrospective Case ◽  
Nuchal Rigidity ◽  
Referral Hospitals ◽  
Meningitis In Children

Objective. It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis. Design. Retrospective case series. Setting and patients. 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period. Main outcome measures. Signs and symptoms of meningitis in patients having associated seizures. Results. Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found. Conclusion. In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.

Traditional medicine poisoning in Zimbabwe: clinical presentation and management in adults

2002 ◽  
Vol 21 (11) ◽  
pp. 579-586 ◽  
Author(s):  
D Tagwireyi ◽  
D E Ball ◽  
C F B Nhachi
Keyword(s):  
Traditional Medicine ◽  
Hospital Admissions ◽  
Case Series ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Therapeutic Modality ◽  
African Countries ◽  
Retrospective Case ◽  
Traditional Medicines ◽  
Referral Hospitals

Traditional medicines (TMs) have been reported as major causes of hospital admissions in some African countries including Zimbabwe. There is, however, still a paucity of information with regards to their clinical presentations. We carried out a retrospective case series of all cases of traditional medicine poisoning (TMP) at eight main referral hospitals in Zimbabwe (January 1998–December 1999 inclusive) to describe the most common signs and symptoms, reasons for, and management of TMP in adults. Where the reasons for taking the TM were known, most cases had taken the medicine for either abdominal pains or aphrodisiac purposes. Nonspecific adverse effects including vomiting, abdominal pains, and diarrhoea were the most commonly encountered. A large proportion of patients with TMP also suffered from genito-urinary tract adverse outcomes especially haematuria and dysuria. Intravenous fluids were the most commonly employed therapeutic modality for TMP, probably in an effort to dilute or increase excretion of the toxins. Further research is required to elucidate the toxic components responsible for the observed ill effects and whether these effects are due to the medicines themselves or to co-existing illnesses.

A ten-year retrospective case series of glucocorticoid treatment of bacterial meningitis in children

2016 ◽  
Vol 105 (8) ◽  
pp. 979-982 ◽  
Author(s):  
Sofia Ygberg ◽  
Annelie Brauner ◽  
Benedict J. Chambers ◽  
Claes Wiklund ◽  
Anna Nilsson
Keyword(s):  
Bacterial Meningitis ◽  
Case Series ◽  
Retrospective Case ◽  
Glucocorticoid Treatment ◽  
Retrospective Case Series ◽  
Meningitis In Children

Orbital relapse in children treated for Pre-B ALL, a retrospective case series

2020 ◽  
pp. 1-7
Author(s):  
Komal Seher ◽  
Saadiya Javed Khan
Keyword(s):  
Central Nervous System ◽  
Bone Marrow ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Case Series ◽  
Signs And Symptoms ◽  
Ocular Tissue ◽  
Cell Leukaemia ◽  
Retrospective Case ◽  
Ocular Lesions

Abstract About 85-90% of children with B-cell leukaemia are cured. If relapse occurs it is usually in the bone marrow (BM), followed by extramedullary sites. Ocular lesions occur secondary to the accumulation of circulating blasts in the uvea, optic disc, intra-ocular tissue as well as fluid. Here we report four patients with ocular complaints that led to the diagnosis of relapse. Among 475 children with leukaemia treated from January 2013 to December 2018, 50 (10.5%) patients relapsed. Four (8%) out of these 50 presented with orbital symptoms. Central Nervous System (CNS) evaluation by cerebrospinal fluid (CSF) was negative at relapse. Relapse was treated with chemotherapy R3 protocol. Three (75%) patients are alive, while the fourth patient had a second BM relapse and died. Ophthalmic signs and symptoms in patients with treated leukaemia warrant a thorough evaluation. Continuous...  

scholarly journals Impact of the Combination of Daptomycin and Trimethoprim-Sulfamethoxazole on Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Infections

2015 ◽  
Vol 59 (4) ◽  
pp. 1969-1976 ◽  
Author(s):  
Kimberly C. Claeys ◽  
Jordan R. Smith ◽  
Anthony M. Casapao ◽  
Ryan P. Mynatt ◽  
Lisa Avery ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Case Series ◽  
Signs And Symptoms ◽  
Retrospective Case ◽  
Methicillin Resistant ◽  
Content Type ◽  
Hospital Stays ◽  
Prolonged Hospital

ABSTRACTComplicatedStaphylococcus aureusinfections, including bacteremia, are often associated with treatment failures, prolonged hospital stays, and the emergence of resistance to primary and even secondary therapies. Daptomycin is commonly used as salvage therapy after vancomycin failure for the treatment of methicillin-resistantS. aureus(MRSA) infections. Unfortunately, the emergence of daptomycin resistance, especially in deep-seated infections, has been reported, prompting the need for alternative or combination therapy. Numerous antibiotic combinations with daptomycin have been investigated clinically andin vitro. Of interest, the combination of daptomycin and trimethoprim-sulfamethoxazole (TMP-SMX) has proved to be rapidly bactericidalin vitroto strains that are both susceptible and nonsusceptible to daptomycin. However, to date, there is limited clinical evidence supporting the use of this combination. This was a multicenter, retrospective case series of patients treated with the combination of daptomycin and TMP-SMX for at least 72 h. The objective of this study was to describe the safety and effectiveness of this regimen in clinical practice. The most commonly stated reason that TMP-SMX was added to daptomycin was persistent bacteremia and/or progressive signs and symptoms of infection. After the initiation of combination therapy, the median time to clearance of bacteremia was 2.5 days. Microbiological eradication was demonstrated in 24 out of 28 patients, andin vitrosynergy was demonstrated in 17 of the 17 recovered isolates. Further research with this combination is necessary to describe the optimal role and its impact on patient outcomes.

scholarly journals Etiology and outcome of culture proven bacterial meningitis in children 6 to 24 months of age.

2019 ◽  
Vol 26 (09) ◽  
pp. 1451-1456
Author(s):  
Muhammad Amin ◽  
Asim Khurshid ◽  
Mukhtar Ahmad ◽  
Zunaira Javed
Keyword(s):  
Bacterial Meningitis ◽  
Neisseria Meningitidis ◽  
Case Series ◽  
Vaccination Status ◽  
Streptococcus Pneumonia ◽  
Neisseria Meningitides ◽  
Life Threatening Illness ◽  
History Of ◽  
Meningitis In Children ◽  
Hemophilus Influenzae Type B

Introduction: Pediatric bacterial meningitis is a life-threatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. More than 2/3 cases of meningitis occur in the 1st 2 years of life, owing to decreased immunity and high vascularity of the brain.This study was conducted to determine the frequency of hemophilus influenzae type b, streptococcus pneumonia and neisseria meningitidis and outcome in culture proven meningitis in children 6 months to 24 months. Study Design: Case series. Setting: Paeds Unit 1, Bahawal Victoria Hospital, Bahawalpur and Paeds Unit of District Headquarter (DHQ) Teaching Hospital, Dera Ghazi Khan. Period: 1st April 2017 to 30th September 2018. Material and Methods: A total of 220 children (110 from each center) of either sex with culture proven meningitis, aged 6 months to 24 months, were included in the study. Demographics, duration of fever, history of seizures, weight of child, vaccination status and bacteria isolated from CSF and outcome were analyzed. The outcome in the form of mortality was noted during the first 10 days of hospital stay. Results: Amongst a total of 220 children, 123 (55.9%) were male. There were 130 (59.1%) children who were less than or equal to 1 year of age. There were 154 (70.0%) children who were having a weight of 7 to 10 kg. Vaccination status was, 111 (50.5%) were fully vaccinated, 59 (26.8%) partially vaccinated and 50 (22.7%) not vaccinated. Duration of fever was, 141 (64.1%) had fever for more than 5 days. There were 139 (63.2%) children who had a history of seizures.  Streptococcus pneumonia was the commonest bacteria found in 110 (50%) children followed by neisseria meningitides 53 (24.1%), H. Influenza 37 (16.8%). Overall mortality was noted in 34 (15.5%) children. Conclusion: In children with bacterial meningitis, mortality was high and most common bacteria were found to be s.pneumoniae followed by neisseria meningitidis and h.influenzae. Awareness about the empiric and directed antimicrobial therapy will help to lower the burden of morbidity and mortality related to bacterial meningitis.

scholarly journals Cataract Surgery Outcomes in New South Wales, Australia

1970 ◽  
Vol 12 (3) ◽  
pp. 124-129
Author(s):  
Rahul Dubey ◽  
Kenny Chan ◽  
Somsak Lertsumitkul ◽  
John Grigg ◽  
Peter Joseph McCluskey
Keyword(s):  
Visual Acuity ◽  
Quality Care ◽  
Case Series ◽  
Complication Rates ◽  
Retrospective Case ◽  
Good Visual Acuity ◽  
South Wales ◽  
Vitreous Loss ◽  
Before And After ◽  
Referral Hospitals

Aim: To prospectively assess the visual acuity outcomes of phacoemulsification surgery in 2 tertiary referral hospitals over an 8-year period, and to compare the outcomes achieved by ophthalmology consultants and registrars in routine clinical practice to assess the appropriateness of patient allocation.Methods: This prospective/retrospective case series of phacoemulsification surgery recruited patients from 1 July 2000 to 30 Dec 2008. Patients underwent detailed ophthalmic examination before and after surgery.Phacoemulsification and insertion of intraocular lens was performed by consultants and senior and junior registrars, who were allocated by the treating consultant. Postoperative review was conducted 1 day, 1 week, 1 month, and 3 months after surgery.Results: Of the 1812 cases, 1596 (88.1%) were complication free. The mean postoperative visual acuity was 0.17 LogMAR (6/9 Snellen equivalent), with 1630 cases (90.0%) achieving 0.30 LogMAR (6/12) or better. Consultants, and senior and junior registrars all achieved similar postoperative visual acuities of 0.15 to 0.17 LogMAR (p = 0.5). There was a significantly different rate of vitreous loss between the 3 groups (p = 0.002), with consultants at 2.9% (9/309), senior registrars at 1.9% (15/804) and junior registrars at 5.3% (37/699).Conclusions: The visual acuity outcomes and complication rates confirm that quality care is being delivered to patients. The different complication rates between consultants and registrars reflect consultants allocating themselves more complicated cases and the training of junior registrars. The similar postoperative visual acuities achieved showed that allocation of patients among consultants and registrars was appropriate and good visual acuity outcomes were delivered to all patients.

Diagnostic Value of Procalcitonin for Bacterial Meningitis in Children: A Comparison Analysis Between Serum and Cerebrospinal Fluid Procalcitonin Levels

2018 ◽  
Vol 58 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Li Zhang ◽  
Lan Ma ◽  
Xianghong Zhou ◽  
Jinhua Meng ◽  
Jie Wen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Serum Albumin ◽  
Diagnostic Value ◽  
Viral Meningitis ◽  
Receiver Operating Characteristics ◽  
Comparison Analysis ◽  
Operating Characteristics ◽  
Receiver Operating Characteristics Curve ◽  
Meningitis In Children

The aim of this study was to analyze and compare procalcitonin (PCT) levels in serum and cerebrospinal fluid (CSF) as tools for detecting bacterial meningitis (BM) in children. Serum and CSF PCT levels as well as albumin index (AI = CSF albumin/serum albumin × 1000) were measured from 29 BM, 25 viral meningitis (VM), and 47 non-meningitis patients. Differences between groups only for CSF PCT were significant. A stronger positive correlation between CSF PCT level and AI was observed in the BM patients ( R = 0.68, P < .001). As a predictor of BM, the area under the receiver operating characteristics curve for CSF PCT was greater than that of serum PCT (0.76 vs 0.67, P < .05) and a cutoff of ⩾0.085 ng/mL achieved 55.17% sensitivity and 95.83% specificity. High levels of CSF PCT may indicate loss of integrity of the blood-brain barrier; only CSF PCT has a diagnostic value for BM in children suspected meningitis.

scholarly journals Role of procalcitonin in viral and bacterial meningitis

2021 ◽  
Vol 8 (7) ◽  
pp. 947
Author(s):  
Nipun Saproo ◽  
Roma Singh
Keyword(s):  
Bacterial Meningitis ◽  
Cross Sectional Study ◽  
Viral Meningitis ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Fluid Analysis ◽  
Bacteriological Profile ◽  
Clinical Presentations ◽  
Meningitis In Children ◽  
One Year

Background: Meningitis is one of the most common central nervous system infections by bacteria, virus or fungus encountered in infants and children.Early diagnosis of meningitis and differentiation of bacterial from non-bacterial/ viral meningitis tends to play an important role in the emergency management of children with suspected meningitis. While cerebrospinal fluid analysis is popular, along with biomarkers: C-reactive protein and white blood cell count, serum procalcitonin seems to offer an even better specificity.Methods: A hospital based cross-sectional-study was conducted in department of neurology in collaboration with department of pathology, Medanta, Medicity, Gurugram, for a period of one year from March 2018 to 2019. 100 children aged 4 months to 12 years, with suspected meningitis were enrolled. The study group was further subdivided into two groups, based upon their bacteriological profile: bacterial meningitis and viral meningitis.Results: For both the groups, the common clinical presentations were fever (100% and 96.88%), convulsions (58.33% and 45.31%), vomiting (25% and 43.75%), The demographic and clinical profile of the 2 groups was largely comparable. Serum PCT levels were significantly higher in bacterial meningitis group compared to non-bacterial meningitis with p<0.001. The sensitivity of serum PCT was found to be 97% and superior to CRP in terms of accuracy in identification and to assess the severity. Procalcitonin is an ideal marker with highest accuracy for bacterial infections.Conclusions: Serum PCT can act as a more sensitive and specific diagnostic tool in early differentiation of bacterial from non-bacterial meningitis in children.

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