The cerebrospinal fluid changes and clinical characteristics of aseptic meningitis in Kawasaki disease

Abstract Background: Aseptic meningitis is not a common feature in Kawasaki disease (KD). However, it could cause difficulty in making correct and in-time diagnosis Methods: We retrospectively investigated patients of KD and bacterial meningitis (BM). Totally 38 KD patients and 126 BM patients were brought into this study. Clinical symptoms, signs and laboratory examinations were compared between the two groups, which included: duration of fever before lumbar puncture, conjunctiva injection, oral cavity change, rash, cervical lymphadenopathy and extremities change, vomiting, front fontanel bulging, neck stiffness, leukocytes, hemoglobin, platelets, C-reactive protein, cerebrospinal fluid examinations, liver function and urinalysis. Results: In clinical signs, vomit and neck stiffness were more prevalent in BM. KD patients showed higher blood leukocyte (p<0.001) and C-reactive protein (p<0.001) in the early febrile stage. Glucose in cerebrospinal fluid of BM patients was significantly lower than KD patients (p=0.003). In ROC curve, the optimal cutoff value of CSF glucose was 2.945mmol/L with the sensitivity of 84.2% and specificity of 71.4%. Pyuria was more prevalent in KD patients (p<0.001). There was no significant difference in front fontanel bulging, hemoglobin, platelet, alanine transaminase, aspartate transaminase, albumin, cerebrospinal fluid leukocytes, cerebrospinal fluid protein and cerebrospinal fluid lactate dehydrogenase. Conclusions ： Full investigation of clinical manifestation and laboratory tests is necessary to distinguish KD with aseptic meningitis and BM. In CSF study, glucose level is more efficient than other items to distinguish these two diseases. Decreased CSF glucose is possibly an indicator of BM rather than KD.

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Cerebrospinal fluid changes and clinical features of aseptic meningitis in patients with Kawasaki disease

Journal of International Medical Research ◽

10.1177/0300060520980213 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098021

Author(s):

Fan Hu ◽

Xiaoqing Shi ◽

Yang Fan ◽

Hanmin Liu ◽

Kaiyu Zhou

Keyword(s):

Cerebrospinal Fluid ◽

Kawasaki Disease ◽

Aseptic Meningitis ◽

Enzyme Level ◽

Clinical Manifestations ◽

Cervical Lymphadenopathy ◽

C Reactive Protein ◽

Neck Stiffness ◽

Laboratory Parameters ◽

Reactive Protein

Objective To assess the distinguishing features of aseptic meningitis (AM) in patients with Kawasaki disease (KD) compared with bacterial meningitis (BM) patients. Methods Thirty-eight patients with KD and 126 patients with BM were retrospectively investigated. The following clinical manifestations and laboratory parameters were compared between the two groups: duration of fever before lumbar puncture, conjunctival injection, oral cavity changes, rash, cervical lymphadenopathy and extremity changes, vomiting, front fontanel bulging, neck stiffness, leukocyte number, hemoglobin level, platelet number, C-reactive protein level, cerebrospinal fluid (CSF) content, liver enzyme level, and urinalysis. Results Vomiting and neck stiffness were more prevalent in patients with BM. KD patients with AM showed elevated blood leukocyte numbers and C-reactive protein levels in the early febrile stage. CSF glucose was significantly lower in patients with BM compared with KD patients with AM. Receiver operating characteristic curve analysis showed that the optimal cutoff value of CSF glucose for discrimination of BM and AM/KD was 2.945 mmol/L, with a sensitivity of 84.2% and a specificity of 71.4%. Conclusions Detailed investigations of clinical manifestation and laboratory parameters are necessary to distinguish AM and BM in patients with KD. Decreased CSF glucose is a potential indicator of BM.

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C - reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis

African Health Sciences ◽

10.4314/ahs.v19i3.10 ◽

2019 ◽

Vol 19 (3) ◽

pp. 2372-2377

Author(s):

Shima Javadinia ◽

Mohsen Tabasi ◽

Mehri Naghdalipour ◽

Najmosadat Atefi ◽

Ramin Asgarian ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Aseptic Meningitis ◽

Great Majority ◽

Diagnostic Value ◽

Latex Agglutination ◽

Neonatal Meningitis ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Permanent Brain Damage

Background: Meningitis, is a potentially life-threatening condition that can rapidly progress to permanent brain damage, neurologic problems, and even death. Bacteria and viruses cause the great majority of meningitis disease in infants and children. CRP is used mainly as a marker of inflammation.Objective: This study was conducted to assess the diagnostic value of CSF-CRP levels for differentiating between septic (bacterial) and aseptic infantile meningitis.Methods: 49 hospitalized infants aged less than two months with suspected meningitis were enrolled in a cross-sectional analytic study. All of patients underwent lumbar puncture to obtain CSF. smears, cultures, cytological and biochemical analysis and latex agglutination testing were carried out on all CSF samples. Latex agglutination test was carried out on all CSF samples using a commercially available kit. CSF-CRP level of all infants was measured using the immunoturbidometric technique.Results: Of 49 infants in this study, 20 and 29 cases were diagnosed as septic and aseptic meningitis, respectively. The CRP levels were obtained as 0.95±0.68 mg/L in septic and 0.16±0.36 mg/L in aseptic meningitis groups and this difference was statistically significant (p<0.001) between the two groups (0.79±0.32 mg/L). Based on the ROC curve, cut off levels for CRP was obtained 0.17 mg/L. At this level, there was 95% sensitivity and 86% specificity to differentiate septic and aseptic meningitis.Conclusion: CSF-CRP has suitable diagnostic value in distinguishing between infantile bacterial from aseptic meningitis especially in cases of negative bacterial culture of the blood and spinal fluid.Keywords: C-reactive protein, cerebrospinal fluid, septic/aseptic meningitis, infant, diagnostic value.

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Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Frontiers in Pediatrics ◽

10.3389/fped.2020.617039 ◽

2021 ◽

Vol 8 ◽

Author(s):

Elisa Fernández-Cooke ◽

Carlos D. Grasa ◽

Sara Domínguez-Rodríguez ◽

Ana Barrios Tascón ◽

Judith Sánchez-Manubens ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Characteristics ◽

Myocardial Dysfunction ◽

Clinical Signs ◽

Pediatric Intensive Care ◽

Terminal Segment ◽

C Reactive Protein ◽

Reactive Protein ◽

Aneurysm Development ◽

Inflammatory Syndrome

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain.Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1–May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV–) to those from the same period during 2018 and 2019 (PreCoV).Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period.Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

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Evaluation of IL-8 level in cerebrospinal fluid in acute bacterial meningitis in adults

Medical Journal of Tabriz University of Medical Sciences and Health Services ◽

10.34172/mj.2021.003 ◽

2021 ◽

Vol 42 (6) ◽

pp. 634-641

Author(s):

Zhinous Bayat-Makoo ◽

Puran Karimi ◽

Negar Mohtadi

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Aseptic Meningitis ◽

High Sensitivity ◽

Interleukin 8 ◽

Acute Bacterial Meningitis ◽

Neck Stiffness ◽

Significant Difference ◽

Level Of Consciousness ◽

Consciousness Disorder

Background: Interleukin 8 increases in various types of meningitis, specifically acute bacterial meningitis inflammation, and it is important in the distinction between types of meningitis. The present paper aims at evaluation of the level of interleukin 8 in cerebrospinal fluid in acute adult bacterial meningitis. Methods: All adult patients’ with diagnosis of suspected meningitis with symptoms of fever, headache, neck stiffness, and consciousness disorder. Lumbar puncture was taken in between the third and fourth vertebra by a specialist physician for all patients suspected with meningitis. To determine the level of consciousness, the GCS of the patients was determined and the cerebrospinal fluid was cultured and sent to the laboratory for the analyses of cell count, diffraction, CSF fluid glucose, CSF fluid protein, LDH, or lactate dehydrogenase, and the level of interleukin 8. Results: The mean of IL-8 protein was 296.17±48.57Pg/ml in patients with aseptic meningitis and 1088.96±526.55Pg/ml in the group of patients with septic meningitis. There was a significant difference between the two groups in terms of the amount of interleukin 8 (p = 0.009). Cutoff was 297.6 Pg/ml for the detection of positive bacterial meningitis with a sensitivity of 92% and the specificity of 83.1% was 297.6 pg/ml. Conclusion: Interleukin 8 has a high sensitivity and specificity in the diagnosis of bacterial meningitis from aseptic meningitis, and along with the measurement of cerebrospinal fluid protein, it can be a good criterion for differentiation of bacterial from aseptic meningitis.

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Abstract 76: Clinical Usefulness Of Serum Procalcionin Level In Kawasaki Disease Children.

Circulation ◽

10.1161/circ.131.suppl_2.76 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Hee Joung Choi ◽

Tae Chan Kwon

Keyword(s):

Kawasaki Disease ◽

Bacterial Infection ◽

Viral Infection ◽

Systemic Inflammation ◽

Clinical Usefulness ◽

C Reactive Protein ◽

Acute Phase Reactants ◽

Reactive Protein ◽

Significant Difference ◽

Immunoglobulin Treatment

Purpose: Procalcitonin (PCT) is one of acute phase reactants such as C-reactive protein (CRP), and is likely to elevate in systemic inflammation, especially bacterial infection. As we know, the CRP level rise in the patients with high fever including Kawasaki disease (KD) and bacterial infection. So we investigated the clinical usefulness of serum PCT level in Kawasaki disease (KD), which is a systemic inflammation caused by vasculitis. Method: From August 2013 to June 2014, a total 336 patients were studied serum PCT level during hospitalization. We enrolled 41 patients of KD, 83 patients with viral infection, and 21 patients with bacterial infection. Result: The patients with KD had significantly higher mean age (24.4±18.1 months), mean body weight (12.1±3.9 Kg), and mean duration of fever prior to admission (4.4±1.8 days) than other patients (p<0.05). The serum PCT level, white blood cell (WBC) and platelet count, neutrophil proportion, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were significantly higher in KD patients than viral infection patients (p<0.05). Although not statistically significant, the serum PCT level was lower in KD patients than bacterial infection patients, whereas the CRP was higher in KD patients than bacterial infection patients. No significant difference in serum PCT level was showed between complete KD patients and incomplete KD patients. Also there was no significant difference in serum PCT level between responders to an initial intravenous immunoglobulin treatment and nonresponders. Conclusion: Serum PCT level may help to differentiate KD from viral infection, but we did not find a significant difference in PCT level between KD and bacterial infection. And the utility of PCT level as clinical marker in KD may be limited.

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Selenium status in neonates with connatal infection

British Journal Of Nutrition ◽

10.1017/s0007114516002208 ◽

2016 ◽

Vol 116 (3) ◽

pp. 504-513 ◽

Cited By ~ 11

Author(s):

Lennart Wiehe ◽

Malte Cremer ◽

Monika Wisniewska ◽

Niels-Peter Becker ◽

Eddy Rijntjes ◽

...

Keyword(s):

Case Control Study ◽

Univariate Analysis ◽

Clinical Signs ◽

C Reactive Protein ◽

X Ray ◽

Reactive Protein ◽

Significant Difference ◽

Potential Impact ◽

Control Study ◽

Se Status

AbstractInfectious diseases impair Se metabolism, and low Se status is associated with mortality risk in adults with critical disease. The Se status of neonates is poorly characterised, and a potential impact of connatal infection is unknown. We hypothesised that an infection negatively affects the Se status of neonates. We conducted an observational case–control study at three intensive care units at the Charité-Universitätsmedizin Berlin, Germany. Plasma samples were collected from forty-four neonates. On the basis of clinical signs for bacterial infection and concentrations of IL-6 or C-reactive protein, neonates were classified into control (n23) and infected (n21) groups. Plasma Se and selenoprotein P (SePP) concentrations were determined by X-ray fluorescence and ELISA, respectively, at day of birth (day 1) and 48 h later (day 3). Se and SePP showed a positive correlation in both groups of neonates. Se concentrations indicative of Se deficit in adults (<20 µg/l) were observed in four infected neonates and one control subject, and three infected neonates had very low SePP concentrations (<0·5 mg/l). The univariate analysis revealed a significant difference in Se and SePP concentrations between the groups. Both parameters correlated inversely to IL-6 in neonates with severe inflammation (IL-6>500 ng/l). During antibiotic therapy, SePP increased significantly from day 1 (1·03 (sd0·10) mg/l) to day 3 (1·34 (sd0·10) mg/l), indicative of improved hepatic Se metabolism. We conclude that both Se and SePP are suitable biomarkers for assessing Se status in neonates and for identifying subjects at risk of deficiency.

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The Occurrence of Coronary Artery Lesions in Kawasaki Disease Based on C-reactive Protein Levels: A Retrospective Cohort Study

10.21203/rs.3.rs-113714/v1 ◽

2020 ◽

Author(s):

Hyo Soon An ◽

Gi-Beom Kim ◽

Mi Kyoung Song ◽

Sang Yun Lee ◽

Hye Won Kwon ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Demographic Data ◽

Artery Aneurysm ◽

Nationwide Survey ◽

Coronary Artery Lesions ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

Z Scores

Abstract BackgroundThis study aimed to assess the occurrence of coronary artery lesions (CAL) in patients with Kawasaki disease (KD) according to serum C-reactive protein (CRP) levels. MethodsThis retrospective analysis was based on the nationwide survey of KD conducted in the Republic of Korea between 2015 and 2017. We enrolled 9131 patients and defined low (<3 mg/dL) and high (≥3 mg/dL) CRP groups. Demographic data, clinical characteristics, z-scores, and scores based on the Japanese criteria for CAL were compared between the two groups. Logistic regression analysis was used to identify CAL risk factors.ResultsThe low CRP group accounted for 23% of patients. A significant difference was observed for the mean age at diagnosis (high vs. low CRP, 34.4 ± 24.9 vs. 31.7 ± 24.8 months, p<0.001) and fever duration (high vs. low CRP, 6.6 ± 2.2 vs. 6.3 ± 2.5 days, p<0.001). A non-response to intravenous immunoglobulin treatment was found in 1377 patients (20.1%) and 225 patients (11.7%) in the high and low CRP groups, respectively (p<0.001). CAL were found in 12.9% and 18.3% of the high and low CRP patients, respectively (p<0.001), based on z-scores; and in 9.9% and 12.5%, respectively (p = 0.001), based on the Japanese criteria in the acute phase. The giant coronary artery aneurysm occurrence ratio was similar between groups (p=1.0).ConclusionsCAL occurred in patients with both high and low CRP. Therefore, patients with KD should be carefully monitored regardless of their CRP levels.

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Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease

10.22541/au.162657937.78880867/v1 ◽

2021 ◽

Author(s):

Chunling Zhou ◽

Yan Zhao ◽

Xia Wang ◽

Ying Huang ◽

Xuewen Tang ◽

...

Keyword(s):

Kawasaki Disease ◽

Inflammatory Markers ◽

Clinical Symptoms ◽

Meta Analysis ◽

Absolute Lymphocyte Count ◽

Cardiac Markers ◽

C Reactive Protein ◽

Laboratory Parameters ◽

Reactive Protein ◽

Inflammatory Syndrome

Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and ESR. In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of NT-proBNP, troponin and AST were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and ALT and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.

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Ability of Procalcitonin and C-Reactive Protein for Discriminating between Bacterial and Enteroviral Meningitis in Children Using Decision Tree

BioMed Research International ◽

10.1155/2021/5519436 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Dmitriy Babenko ◽

Aliya Seidullayeva ◽

Dinagul Bayesheva ◽

Bayan Turdalina ◽

Baurzhan Omarkulov ◽

...

Keyword(s):

Decision Making ◽

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Decision Tree ◽

Clinical Signs ◽

Acute Bacterial Meningitis ◽

C Reactive Protein ◽

Public Health Burden ◽

Reactive Protein ◽

Enteroviral Meningitis

Bacterial meningitis (BM) is a public health burden in developing countries, including Central Asia. This disease is characterized by a high mortality rate and serious neurological complications. Delay with the start of adequate therapy is associated with an increase in mortality for patients with acute bacterial meningitis. Cerebrospinal fluid culture, as a gold standard in bacterial meningitis diagnosis, is time-consuming with modest sensitivity, and this is unsuitable for timely decision-making. It has been shown that bacterial meningitis differentiation from viral meningitis could be done through different parameters such as clinical signs and symptoms, laboratory values, such as PCR, including blood and cerebrospinal fluid (CSF) analysis. In this study, we proposed the method for distinguishing the bacterial form of meningitis from enteroviral one. The method is based on the machine learning process deriving making decision rules. The proposed fast-and-frugal trees (FFTree) decision tree approach showed an ability to determine procalcitonin and C-reactive protein (CRP) with cut-off values for distinguishing between bacterial and enteroviral meningitis (EVM) in children. Such a method demonstrated 100% sensitivity, 96% specificity, and 98% accuracy in the differentiation of all cases of bacterial meningitis in this study. These findings and proposed method may be useful for clinicians to facilitate the decision-making process and optimize the diagnostics of meningitis.

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AB0735 POLYMORPHISMS OF GENES CD14, C-REACTIVE PROTEIN, FIBRINOGEN BETA CHAIN, ASSOCIATED WITH THE DEVELOPMENT OF KAWASAKI DISEASE AND CORONARY ARTERY ANEURYSMS IN CHILDREN FROM CENTRAL RUSSIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2807 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1397.2-1397

Author(s):

M. Kantemirova ◽

S. Kurbanova ◽

Y. Novikova ◽

A. Glazyrina ◽

M. Azova ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Gene Polymorphism ◽

Control Group ◽

Beta Chain ◽

C Reactive Protein ◽

Coronary Artery Aneurysms ◽

Allele Distribution ◽

Reactive Protein ◽

Significant Difference

Background:Kawasaki disease (KD) is a multifactorial disease with a genetic predisposition, systemic vasculitis complicated by the formation of coronary artery aneurysms (CAA). Its pathogenesis is based on immune inflammation with an increase in the concentration of pro-inflammatory cytokines, the level of C-reactive protein (CRP), and coagulation disorder.Objectives:to search for polymorphisms of genes cluster of differentiation CD14, CRP, fibrinogen beta chain (FGB), associated with the KD development and a predisposition to the CAA formation among patients with KD living in Moscow and the Moscow region.Methods:genotyping for gene polymorphisms CD14 –159 C>T (rs2569190), CRP 3872 C>T (rs1205), FGB – 455 G>A (rs1800790) by PCR in 31 children 1 month – 10 years old (median age 19 months [9,0; 38,5]) with KD, among them, in 10 patients the disease was complicated by CAA formation according to echocardiography, and 30 children of the control group.Results:Three out of six investigated SNPs showed statistically significant difference in genotype and allele distribution: СRP C3872T, CD14 C159T and FGB G455A. CRP gene polymorphism: in patients with KD significantly less frequent is homozygous type TT (RR 0,22, 95% CI: 0,05–0,91, p=0,0168).CD14 gene polymorphism: in control group heterozygous genotype CT is predominant, (RR 0,58, 95% CI: 0,4–0,83, p=0,0017) among patients with KD homozygous genotypes CC and TT are predominant. (RR 3,61, 95% CI: 1,14–11,49, p=0,0057).FGB gene polymorphism: genotype GA is predominant in control group (RR 0,48, 95% CI: 0,26–0,9, p=0,0149). In patients with KD significantly less frequent is homozygous type GG (RR 1,69, 95% CI: 1,03–2,8, p=0,0297).We didn’t find any significant difference in genotype and allele distribution in KD patients with and without CA lesions.Conclusion:statistically significant differences (p<0,05) were revealed in the distribution of genotypes for polymorphisms of the CD14 –159 C>T, CRP 3872 C>T and FGB –455 G>A genes among patients with KD and children of the control group; when comparing the results of KD patients with CAA and the control group, statistically significant differences (p<0,05) were revealed only in the polymorphism CD14 –159 C>T. It can be assumed that these polymorphisms are associated with the development of KD and CAA in these patients.Disclosure of Interests:None declared

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