Laboratory finding of CSF analysis in patients with meningitis at Elamin Hamid Pediatrics Hospital in Khartoum, Sudan

Bacterial meningitis in infants and children is a serious clinical entity with signs and symptoms that commonly do not allow distinguishing the diagnosis and the causative agents. The only method to determine if meningitis is the cause of these symptoms is a lumbar puncture. Lumbar puncture is the gold standard for the diagnosis and should be done in all suspected cases of meningitis unless contraindicated. Objectives: The purpose of this study is to identify the importance of the microbiological study of cerebrospinal fluid (CSF) in patients suspected to have acute meningitis. Despite the availability of all other investigations and Imaging for diagnosis of meningitis but CSF analysis remains the most available, accurate, and cheaper for diagnosis of meningitis in children. Methodology and result: This is a prospective study. 71 patients were included. All patients were clinically suspected to have acute meningitis. A lumbar puncture for CSF analysis was done for all patients. The data was collected and analysed. CSF culture was done. The culture was negative In 58 patients (81.7%) and positive in 13 patients (18.3%). Streptococcus was found in 3 patients (4.2 %), staphylococcus epidermidis in 2 patients (2.8%), E Coli in 2 patients (2.8%), klebsiella in 2 patients (2.8%), pneumococci in 2 patient (2.8%), salmonella in 1 patient (1,4%) and Bacilli in 1 patient (1.4 %). Recommendation: Lumbar Puncture (LP) remains the easiest, cheapest and accurate investigation for diagnosis of meningitis in children mainly in rural areas in Sudan and other developing countries. It’s mandatory to offer training for doctors and medical staff for doing lumber punctures safely and accurately and to offer well-equipped laboratories for such essential investigations. It’s not only the role of doctors and medical staff but is a governmental obligation as well. This can save a lot of sick children and prevent mortality and morbidity of acute meningitis in children.

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

PEDIATRICS ◽

10.1542/peds.92.4.527 ◽

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.

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What is the risk of bacterial meningitis in infants who present to the emergency department with fever and pyuria?

CJEM ◽

10.1017/s1481803500008630 ◽

2003 ◽

Vol 5 (06) ◽

pp. 394-399 ◽

Cited By ~ 8

Author(s):

Ran D. Goldman ◽

Anne Matlow ◽

Lauren Linett ◽

Dennis Scolnik

Keyword(s):

Emergency Department ◽

Bacterial Meningitis ◽

Lumbar Puncture ◽

White Blood Cells ◽

Retrospective Chart Review ◽

Shunt Infection ◽

Urine Specimen ◽

Csf Analysis ◽

Sick Children ◽

Rule Out

ABSTRACTObjectives:To determine the rate of bacterial meningitis among febrile infants in the emergency department (ED) who have pyuria detected in an initial catheterized urine specimen.Methods:This retrospective chart review, conducted at the Hospital for Sick Children, Toronto, Ont., involved all children aged 0 to 3 months who presented to the ED with fever and pyuria (≥10 white blood cells/mm3) over a 3-year period. Cerebrospinal fluid (CSF) was evaluated using standard methods, and the rate of meningitis in children with pyuria was determined.Results:The study sample included 211 infants with fever and pyuria — 79 of these under 1 month of age. Eighty-one percent (171/211) had positive urine cultures, and 143 underwent lumbar puncture to rule out meningitis. Of these, 140 CSF samples were culture negative and 3 grew coagulase negativeStaphylococcus— 2 because of contamination and 1 because of a ventriculo-peritoneal shunt infection. Both children with CSF contamination grewEscherichia coliin the urine. The rate of bacterial meningitis in the study sample was 0% (95% confidence interval, 0%–2.6%).Conclusions:In this study of febrile children under 90 days of age with fever and pyuria, the incidence of concurrent meningitis was 0%. This suggests that recommendations for mandatory lumbar puncture in such children should be reconsidered. However, until larger prospective studies define a patient subset that does not require CSF analysis, it is prudent to rule out meningitis, administer parenteral antibiotics for urinary tract infection, and admit for close observation.

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Tuberculous Meningitis in Children: A Review of 15 Cases

Scottish Medical Journal ◽

10.1177/003693308803300105 ◽

1988 ◽

Vol 33 (1) ◽

pp. 205-207 ◽

Cited By ~ 3

Author(s):

P. Galea ◽

K. M. Goel

Keyword(s):

Close Contact ◽

Signs And Symptoms ◽

Complete Recovery ◽

Neurological Status ◽

X Rays ◽

Duration Of Symptoms ◽

Bcg Vaccination ◽

Modes Of Presentation ◽

Meningitis In Children ◽

Sick Children

Tuberculosis meningitis (TBM) is the most serious form of infection with Mycobacterium: tuberculosis. Between 1968 and 1986 15 children (five boys and 10 girls) were seen at the Royal Hospital for Sick Children, Glasgow, because of TBM. Fourteen children were Caucasian and one was Asian. The mean age at presentation was two years. None had been given BCG vaccination. In 12 children close contact with other cases of tuberculosis was reported. The signs and symptoms which helped in the diagnosis are discussed together with the initial CSF findings, results of mantoux testing and chest X-rays. Three children had unusual modes of presentation. All children were treated with chemotherapy though the drug combinations, route of administration and therapy varied from case to case. Steroids were used in nine children. Five children required neurosurgical intervention. Two children died and of the survivors six had serious sequelae. Five children made a complete recovery. The outcome of TBM depended on the duration of symptoms prior to the onset of therapy, on the neurological status reached at the time of diagnosis and the age of the child. The roles of chemotherapy, steroids and neurosurgery in the management of TBM are discussed. The need for routine BCG vaccination of all neonates is examined.

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Prevalence of Common Infectious Diseases in Paediatric Age Group Admitted in Children’s Hospital Lahore, Pakistan

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v1i1.12 ◽

2017 ◽

Vol 1 (1) ◽

pp. 19-28

Author(s):

Muhammad Rashid ◽

Iqbal Bano ◽

Asif Hanif

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Rural Areas ◽

Urban Areas ◽

Enteric Fever ◽

Winter Season ◽

Signs And Symptoms ◽

Watery Diarrhoea ◽

Mortality And Morbidity ◽

Common Infectious Disease

Background: Infectious diseases are common causes of presenting in emergency having severe signs and symptoms. Having significant mortality and morbidity are on the rise in Pakistan. The objective of the study was to determine the prevalence of infectious diseases in paediatric population.Methodology: We studied 200 consecutive patients from 1 month to 12 years of age presenting with infectious diseases. Their detailed history was then taken including symptoms at presentation and the type of infection was assessed with the help of history and laboratory investigations. Following are the common infectious diseases including pneumonia, meningitis, enteric fever, malaria, measles, tuberculosis, acute watery diarrhoea.Results: Frequency wise infectious diseases are pneumonia (63.5%), meningitis (20%), acute watery diarrhoea (8.5%), enteric fever (4%), malaria (2%), tuberculosis (2%), and no measles case found. Infectious diseases are more common in rural areas than urban areas and success after treatment is more (49.5) than death (2%) but a bad impact is that (48.5%) patient went without treatment.Conclusion: This data is taken in winter season that is why Pneumonia is most common infectious disease, second most common infectious disease is meningitis, and others are acute watery diarrhoea, enteric fever, malaria and tuberculosis in our patients. The awareness of risk factors amongst the public is low. Thus, there is an urgent need to create more and more awareness about the preventive aspects and healthier life style behaviour in our community.

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Predictors of meningitis in children presenting with first episode of febrile seizure

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20164593 ◽

2016 ◽

Vol 4 (1) ◽

pp. 136

Author(s):

Suresh Reddy D. ◽

Habib Khan S. ◽

Pavan Hegde

Keyword(s):

Bacterial Meningitis ◽

Lumbar Puncture ◽

Febrile Seizure ◽

Febrile Seizures ◽

Good Prognosis ◽

Acute Bacterial Meningitis ◽

First Episode ◽

Medical College ◽

Csf Analysis ◽

Meningitis In Children

Background: Febrile seizure is the most common cause of seizures in infants and toddlers presenting to the paediatric emergency department. Two to five percent of children experience at least one or more episodes of febrile seizures. Simple febrile seizures are benign and self-limiting. They have good prognosis and carry very low risk for epilepsy. Probability of acute bacterial meningitis presenting as fever with seizures varies from 0.6% to 6.7%. The American Academy of Paediatrics (AAP) strongly recommends lumbar puncture (for CSF analysis) in the work up of every child under 18 months of age with a first episode of febrile seizure to rule out acute bacterial meningitis. The objective of this study was to determine the occurrence of meningitis in children who presented with first episode of seizure and fever and also the predictors of meningitis among them.Methods: The records of children admitted to Father Muller Medical College and Hospital between 1st January 2014 to 31st December 2015 were reviewed. All children between 6 months to 6 years of age having first episode of convulsions, associated with fever were included in the study and subjected to retrospective analysis of data collected from the case sheets. Results: Our study included 105 children with febrile seizures, 49 children had simple febrile seizures (SFS) and 56 children presented as atypical febrile seizures (AFS). Lumbar puncture was performed in 43 children (15 with SFS and 28 with AFS). The CSF analysis was normal in all the children who presented as simple febrile seizures. There was 25.87% prevalence of meningitis in children with atypical febrile seizures who underwent lumbar puncture. The CSF yield suggestive of bacterial meningitis was as high as 50% in children below 1 year in whom lumbar puncture was done.Conclusions: Children presenting with Atypical/Complex febrile seizures who were treated with antibiotics have more likelihood of having meningitis rather than those presenting with simple febrile seizures.

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Psychological impact and implementation of preventative measures in hemodialysis centers during the COVID-19 pandemic: a provincial questionnaire survey in China

International Urology and Nephrology ◽

10.1007/s11255-021-02875-x ◽

2021 ◽

Author(s):

Yuanhan Chen ◽

Yanhua Wu ◽

Penghua Hu ◽

Xia Fu ◽

Shuangxin Liu ◽

...

Keyword(s):

Rural Areas ◽

Questionnaire Survey ◽

Medical Staff ◽

Psychological Impact ◽

Guangdong Province ◽

Psychological Status ◽

Staff Members ◽

Preventative Measures ◽

Tertiary Hospitals ◽

Novel Coronavirus

Abstract Objectives This study investigated the psychological status of patients and staff, and the implementation of preventative measures in hemodialysis centers in Guangdong province, China, during the 2019 novel coronavirus disease (COVID-19) pandemic. Methods An electronic questionnaire survey was carried out anonymously between March 28 and April 3, 2020. All of the 516 hemodialysis centers registered in Guangdong province were invited to participate in the survey. The questionnaires were designed to investigate the psychological status of hemodialysis patients and general staff members (doctors, nurses, technicians, and other staff), and to address the implementation of preventative measures for administrators (directors or head nurses) of the hemodialysis centers. Results A total of 1782 patients, 3400 staff, and 420 administrators voluntarily participated in this survey. Patients living in rural areas reported a higher incidence of severe anxiety compared to those living in other areas (in rural areas, towns, and cities, the incidence rate was 17.0%, 9.0%, and 8.9%, respectively, P < 0.001). Medical staff were less likely to worry about being infected than non-medical staff (13.1% vs 30.3%, respectively, P < 0.001). With respect to the implementation of preventative measures, hemodialysis centers in general hospitals outperformed stand-alone blood purification centers, while tertiary hospitals outperformed hospitals of other levels. However, restrictions regarding the admission of non-resident patients were lower in tertiary hospitals than in other hospitals. In this situation, only one patient imported from Hubei province was diagnosed with COVID-19. Conclusions COVID-19 did not significantly affect the psychological status of most patients and medical staff members. Due to the implementation of comprehensive preventative measures, there were no cluster outbreaks of COVID-19 in hemodialysis centers. This provincial-level survey may provide referential guidance for other countries and regions that are experiencing a similar pandemic.

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Assessment Framework for Recognizing Clinical Deterioration in Patients With ACS Undergoing PCI

Critical Care Nurse ◽

10.4037/ccn2021904 ◽

2021 ◽

Vol 41 (4) ◽

pp. 18-28

Author(s):

Kevin White ◽

Judy Currey ◽

Julie Considine

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Signs And Symptoms ◽

Coronary Artery Occlusion ◽

Coronary Intervention ◽

Clinical Deterioration ◽

Access Site ◽

Mortality And Morbidity ◽

Coronary Syndrome ◽

Percutaneous Coronary

Topic Patients with acute coronary syndrome undergoing primary percutaneous coronary intervention are at risk of clinical deterioration that results in similar general signs and symptoms regardless of its cause. However, specific causes and forms of clinical deterioration are associated with key differences in assessment findings. Focused clinical assessments using a modified primary survey enable nurses to rapidly identify the cause and form of clinical deterioration, facilitating targeted treatment. Clinical Relevance Clinical deterioration during percutaneous coronary intervention is associated with increased mortality and morbidity. Previous studies identified nursing inconsistencies when recognizing clinical deterioration, with inconsistent collection of cues and prioritization of cues related to cardiac performance over more sensitive indicators of clinical deterioration. Purpose of Paper To describe a framework to help nurses optimize physiological cue collection to improve recognition of clinical deterioration during periprocedural care of patients undergoing percutaneous coronary intervention for unstable acute coronary syndrome. Content Covered Literature analysis revealed 7 forms of clinical deterioration in patients undergoing percutaneous coronary intervention: coronary artery occlusion, stroke, ventricular rupture, valvular insufficiency, lethal cardiac arrhythmias, access-site and non–access-site bleeding, and anaphylaxis. Evidence for the pathophysiology, incidence, severity, and clinical features of each form of clinical deterioration is identified. A framework is proposed to help nurses conduct highly focused patient assessments, enabling prompt recognition of and response to the specific forms of clinical deterioration that occur in patients undergoing percutaneous coronary intervention.

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Coping Strategies and Health-Related Quality of Life in Pregnant Women with SARS-CoV-2 Infection

Medicina ◽

10.3390/medicina57101113 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1113

Author(s):

Madalina Timircan ◽

Felix Bratosin ◽

Iulia Vidican ◽

Oana Suciu ◽

Mirela Turaiche ◽

...

Keyword(s):

Quality Of Life ◽

Pregnant Women ◽

Rural Areas ◽

Short Form ◽

Depression Scale ◽

Morbidity Rate ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Physical Burden

Background and Objectives: As maternal deaths associated with the SARS-CoV-2 infection remain at several times greater than the general population, significant factors that might contribute to the higher mortality and morbidity rate are the psychological impact of the disease and pregnancy itself. Therefore, the current study’s main objective was to assess how pregnant women react and cope with the stress of COVID-19 disease and how it influences their overall health and quality of life in healthcare facilities. Materials and Methods: In this cross-sectional study, we included 304 pregnant women who successfully completed standardized forms to assess our topics of interest, comprising of the Hospital Anxiety and Depression Scale, the Short Form Health Survey-12, the Coping Orientation to Problems Experienced Inventory scale, the CORE-Outcome Measure Questionnaire, and the Quality from the Patient’s Perspective questionnaire. Results: Unemployed, pregnant women living in poverty in the rural areas had higher SARS-CoV-2 infection rates during pregnancy. They faced higher anxiety levels and depression rates, with associated increased physical burden and exhaustion. However, these findings are not influenced by hospital care since it remained unchanged among COVID-19 and non-COVID-19 maternity units, excepting significantly lower technical competence scores of COVID-19 facilities. Conclusions: As the pandemic’s consequences emerge and additional outbreaks occur, care must prioritize the additional physical burden experienced by pregnant women who have contracted COVID-19, as well as psychological, emotional, and mental health support.

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Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2019-0008 ◽

2019 ◽

Vol 2 (1) ◽

pp. 35-40

Author(s):

Daniel Ion ◽

Dan Nicolae Păduraru ◽

Florentina Mușat ◽

Octavian Andronic ◽

Alexandra Bolocan

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Abdominal Trauma ◽

Clinical Signs ◽

Signs And Symptoms ◽

Management Plan ◽

Intraabdominal Pressure ◽

Mortality And Morbidity ◽

Abdominal Hypertension ◽

Abdominal Compartment

AbstractThe clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

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Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/568169 ◽

2014 ◽

Vol 25 (5) ◽

pp. 249-251 ◽

Cited By ~ 24

Author(s):

Ryota Hase ◽

Naoto Hosokawa ◽

Makito Yaegashi ◽

Kiyoharu Muranaka

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Lumbar Puncture ◽

Early Stage ◽

Review Of The Literature ◽

Csf Analysis ◽

Cell Counts ◽

Csf Pleocytosis ◽

Cerebrospinal Fluid Pleocytosis ◽

Rule Out

Elevation of cerebrospinal fluid (CSF) cell count is a key sign in the diagnosis of bacterial meningitis. However, there have been reports of bacterial meningitis with no abnormalities in initial CSF testing. This type of presentation is extremely rare in adult patients. Here, a case involving an 83-year-old woman who was later diagnosed with bacterial meningitis caused byNeisseria meningitidisis described, in whom CSF at initial and second lumbar puncture did not show elevation of cell counts. Twenty-six non-neutropenic adult cases of bacterial meningitis in the absence of CSF pleocytosis were reviewed. The frequent causative organisms wereStreptococcus pneumoniaeandN meningitidis. Nineteen cases had bacteremia and seven died. The authors conclude that normal CSF at lumbar puncture at an early stage cannot rule out bacterial meningitis. Therefore, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately if there are any signs of sepsis or meningitis.

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