scholarly journals C-REACTIVE PROTEIN (CRP) AS A SUPPORTING MARKER OF ANTIBIOTIC EFFECTIVENESS ON CENTRAL NERVOUS SYSTEM (CNS) INFECTIONS

2016 ◽  
Vol 51 (3) ◽  
pp. 149
Author(s):  
Melawati Olevianingrum ◽  
Yulistiani Yulistiani ◽  
Darto Saharso ◽  
Nun Zairina
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Antibiotic Therapy ◽  
Pediatric Patients ◽  
Clinical Laboratory ◽  
Empiric Antibiotic Therapy ◽  
Antibiotic Administration ◽  
Central Nervous System Infections ◽  
The Third ◽  
Cns Infections

Infection of the central nervous system in pediatric patients have a high mortality as well as acute and chronic neurological sequelae. Signs of the disease are unclear, so cerebrospinal fluid (CSF) test is used as a gold standard for diagnosis, but the investigation has faced many obtacles. Empiric antibiotic therapy is the key factor in reducing morbidity and mortality. Microbiological culture result is obtained within 5-7 days. The effectiveness of empirical antibiotic use is questionable. Therefore, other investigations are conducted to determine the effectiveness of antibiotics by using one marker, the CRP. This study was to analyze CRP level in supporting antibiotic therapy effectiveness in pediatric patients with central nervous system (CNS) infections. A prospective cohort study was conducted to determine the relationship of CRP with other parameters, including clinical, microbiological and laboratory, in pediatric patients with central nervous system infections. Patients meeting blood samples criteria were taken before (H0), the third day (H3) and the fifth day (H5) after antibiotics administration. This study involved 10 patients with central nervous system infections (meningoencephalitis, encephalitis and encephalitis with cerebral edema). Six patients were male, with ages less than a year. Antibiotic treatment effectiveness was associated with improved condition of the patients' CRP level. It was 3.558 ±3.196 before (H0), 3.878±2.813 on the third day (H3) and 3.891±2.204 on the fifth day (H5) after antibiotic administration. Leukocyte levels were 13.680±1.660 before (H0), 17.832±7.213 on the third day (H5), and 10.546±3.671 on the fifth day (H5) after antibiotic administration. Pearson's correlation test analysis performed on CRP and WBC parameters showed H0 p=0.981, CRP and WBC H3 p=0.621, while CRP and WBC H5 obtained significance p=0.644. There was no significant correlation observed between CRP and WBC parameters before and after antibiotic administration. In conclusion, there was no correlation of CRP levels with clinical, laboratory and micobiological parameters in patients with central nervous system infections.

Single-dose ceftriaxone pharmacokinetics in pediatric patients with central nervous system infections

1983 ◽  
Vol 102 (1) ◽  
pp. 134-137 ◽  
Author(s):  
E. Gould Chadwick ◽  
R. Yogev ◽  
S.T. Shulman ◽  
R.E. Weinfeld ◽  
I.H. Patel
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Single Dose ◽  
Pediatric Patients ◽  
Central Nervous System Infections

scholarly journals Molecular Epidemiology of Enterovirus in Children with Central Nervous System Infections

Viruses ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 100
Author(s):  
Lamprini Posnakoglou ◽  
Elizabeth-Barbara Tatsi ◽  
Panagiota Chatzichristou ◽  
Tania Siahanidou ◽  
Christina Kanaka-Gantenbein ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Molecular Epidemiology ◽  
Seasonal Distribution ◽  
Cns Infection ◽  
Pediatric Hospital ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Epidemiology Data ◽  
Of Greece

Limited recent molecular epidemiology data are available for pediatric Central Nervous System (CNS) infections in Europe. The aim of this study was to investigate the molecular epidemiology of enterovirus (EV) involved in CNS infections in children. Cerebrospinal fluid (CSF) from children (0–16 years) with suspected meningitis–encephalitis (ME) who were hospitalized in the largest pediatric hospital of Greece from October 2017 to September 2020 was initially tested for 14 common pathogens using the multiplex PCR FilmArray® ME Panel (FA-ME). CSF samples positive for EV, as well as pharyngeal swabs and stools of the same children, were further genotyped employing Sanger sequencing. Of the 330 children tested with FA-ME, 75 (22.7%) were positive for EV and 50 different CSF samples were available for genotyping. The median age of children with EV CNS infection was 2 months (IQR: 1–60) and 44/75 (58.7%) of them were male. There was a seasonal distribution of EV CNS infections, with most cases detected between June and September (38/75, 50.7%). EV genotyping was successfully processed in 84/104 samples: CSF (n = 45/50), pharyngeal swabs (n = 15/29) and stools (n = 24/25). Predominant EV genotypes were CV-B5 (16/45, 35.6%), E30 (10/45, 22.2%), E16 (6/45, 13.3%) and E11 (5/45, 11.1%). However, significant phylogenetic differences from previous described isolates were detected. No unusual neurologic manifestations were observed, and all children recovered without obvious acute sequelae. Specific EV circulating genotypes are causing a significant number of pediatric CNS infections. Phylogenetic analysis of these predominant genotypes found genetic differences from already described EV isolates.

scholarly journals Metagenomic Next-generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Central Nervous System infections in HIV-infected patients

2019 ◽  
Author(s):  
Nai qing Zheng ◽  
Pengle Guo ◽  
Xiejie Chen ◽  
Haolan He ◽  
Yueping Li ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Next Generation Sequencing ◽  
Clinical Diagnosis ◽  
Central Nervous System Infection ◽  
Next Generation ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Conventional Methods ◽  
Generation Sequencing

Abstract Background HIV-infected patients have extremely low immunity and various opportunistic infections. Early diagnosis and treatment of these pathogens is critical for patients with HIV infection, especially those with central nervous system (CNS) infections. Metagenomic next generation sequencing (mNGS) has the advantage of identifying a broad range of pathogens and was suggested as a promising tool in the clinical diagnosis for infectious diseases. The clinical application of mNGS in the diagnosis of CNS infections in patients infected with HIV remains inadequately characterized.Methods We retrospectively analyzed data from 22 patients with suspected central nervous system infections who underwent both mNGS and conventional methods including culture, PCR, X-pert/RIF and antigen testing to explored the utility of mNGS in clinical diagnostic microbiology of CNS infections in HIV-infected patients.Results A total of 22 patients participated in the study between June 2018 and May 2019. The consistency of positive percentage of mNGS compared to clinical diagnosis was significantly higher than that of conventional methods (86.36% vs. 45.21%). The proportion of co-infections in mNGS positive samples was significantly higher than that in traditional methods (40.91% vs. 14.39%). Sixteen Extra Pathogens in 14 cases identified by metagenomic NGS only, 6 pathogens affected clinical reasoning and 7 pathogens guided antimicrobial therapy.Conclusions MNGS is a powerful diagnostic method for identifying pathogens in central nervous system infections and provide actionable information in some cases. MNGS technology has positive significance for the diagnosis and clinical treatment of central nervous system infection in HIV-infected patients.

scholarly journals Update on Viral Infections Involving the Central Nervous System in Pediatric Patients

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 782
Author(s):  
Giovanni Autore ◽  
Luca Bernardi ◽  
Serafina Perrone ◽  
Susanna Esposito
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pediatric Patients ◽  
Treatment Strategies ◽  
Cns Infection ◽  
Pcr Analysis ◽  
Emerging Pathogens ◽  
Cns Infections ◽  
The Central Nervous System

Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.

scholarly journals Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

2019 ◽  
Vol 57 (5) ◽  
Author(s):  
A. Sasidharan ◽  
C. J. Harrison ◽  
D. Banerjee ◽  
R. Selvarangan
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Kansas City ◽  
Maximum Temperature ◽  
Cns Infection ◽  
Test Results ◽  
Central Nervous System Infections ◽  
Laboratory Findings ◽  
Cns Infections ◽  
Laboratory Test Results

ABSTRACT Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n = 1/4), followed by detections in 2014 (n = 1/39), 2015 (n = 6/9), and 2016 (n = 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n = 11) were compared with those of select PeV-A3-infected children (n = 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P = 0.017) and fever duration was shorter (P = 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P = 0.014) and absolute lymphocyte (P = 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

scholarly journals Cranial Imaging and Lumbar Puncture in Patients With Suspected Central Nervous System Infection

2019 ◽  
Vol 70 (12) ◽  
pp. 2469-2475 ◽  
Author(s):  
Joost M Costerus ◽  
Cynthia M C Lemmens ◽  
Diederik van de Beek ◽  
Matthijs C Brouwer
Keyword(s):  
Emergency Department ◽  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Infection ◽  
Cns Infection ◽  
Antibiotic Administration ◽  
Treatment Delays ◽  
Cns Infections ◽  
Poor Outcomes ◽  
The Times

Abstract Background Performing cranial imaging prior to lumbar punctures (LPs) in patients with suspected central nervous system (CNS) infections has been associated with delayed treatments and poor outcomes. Various guidelines provide different criteria for cranial imaging prior to LP. Methods We describe the use of cranial imaging in a cohort of adult patients with suspected CNS infections, and evaluated adherence to the recommendations made in the Infectious Disease Society of America (IDSA), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Swedish, and Dutch guidelines. We also analyzed the association between cranial imaging and the time between emergency department entrance and intravenous antibiotic administration. Results From 2012–2015, 203 patients with suspected CNS infections were included, of whom 56 (27%) were diagnosed with CNS infections and 16 were diagnosed with bacterial meningitis (8%). Cranial imaging, in all cases computed tomography (CT), was performed in 130 patients (64%) and led to the deferral of LPs in 7 (5%). Criteria by the IDSA, ESCMID, Swedish, and Dutch guidelines showed indications for imaging in 64%, 39%, 39%, and 40% of patients, respectively. The times between emergency department arrivals and the start of antibiotic therapy between patients with and without CT before LP were similar (median 134 [interquartile range (IQR) 58–292] vs. 141 minutes [IQR 52–227], respectively; Mann-Whitney U P = .74). Conclusions A cranial CT prior to LP was done in the majority of patients with a suspected CNS infection, irrespective of guideline indications. The ESCMID, Swedish, and Dutch guidelines were more restrictive in advising imaging, compared to the IDSA guidelines. Performing cranial imaging prior to LP was not associated with treatment delays in this Dutch cohort study.

scholarly journals Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Peter E. Ekanem ◽  
Anne C. K. Nyaga ◽  
Niguse Tsegay ◽  
Haftamu Ebuy ◽  
Elizabeth A. Imbusi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cerebral Palsy ◽  
Vaginal Delivery ◽  
Maternal Education ◽  
Pediatric Patients ◽  
Northern Ethiopia ◽  
Central Nervous System Infections ◽  
Operative Vaginal Delivery ◽  
Education Status

Introduction. Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country. Objective. To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019. Methods. An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27. Results. Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31–68.88), central nervous system infections (AOR: 0.02, 95% CI: 0–0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03–0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15–161.73). Conclusion. Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.

scholarly journals Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

2018 ◽  
Vol 56 (11) ◽  
Author(s):  
Ryan M. Martin ◽  
Lara L. Zimmermann ◽  
Mindy Huynh ◽  
Christopher R. Polage
Keyword(s):  
Health Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Diagnostic Approach ◽  
Central Nervous System Infections ◽  
Cns Infections ◽  
Neurosurgical Patients ◽  
Definition Of

ABSTRACTHealth care- and device-associated central nervous system (CNS) infections have a distinct epidemiology, pathophysiology, and microbiology that require a unique diagnostic approach. Most clinical signs, symptoms, and tests used to diagnose community-acquired CNS infections are insensitive and nonspecific in neurosurgical patients due to postsurgical changes, invasive devices, prior antimicrobial exposure, and underlying CNS disease. The lack of a standardized definition of infection or diagnostic pathway has added to this challenge. In this review, we summarize the epidemiology, microbiology, and clinical presentation of these infections, discuss the issues with existing microbiologic tests, and give an overview of the current diagnostic approach.

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