scholarly journals CLINICAL PRESENTATION, LABORATORY ANALYSIS AND LINEAR GROWTH IN 50 NEONATES AND YOUNG INFANTS WITH ACUTE MENINGITIS: ONE YEAR EXPERIENCE OF A SINGLE CENTER IN QATAR

2019 ◽  
Vol 11 (1) ◽  
pp. e2019028
Author(s):  
Vincenzo De Sanctis
Keyword(s):  
Weight Gain ◽  
Bacterial Meningitis ◽  
Aseptic Meningitis ◽  
Linear Growth ◽  
Clinical Presentation ◽  
Growth Parameters ◽  
Acute Bacterial Meningitis ◽  
Young Infants ◽  
Acute Meningitis

Abstract Introduction: Meningitis occurs frequently in neonates and can lead to a number of acute, severe complications and long-term disabilities. Although, long term growth delay and abnormal weight gain appear to be risk factors following an acute attack of both bacterial and aseptic meningitis in children, especially during the fast phase of infantile growth, the long-term effects of acute meningitis occurring during the neonatal and early infantile periods on linear growth (length, weight and head growth) have not fully reported. Aim of the study: The objective of this study is to describe the clinical presentation of neonates and young infants with acute meningitis with different etiologies and to determine the clinical impact of the effect of acute meningitis on growth parameters. Material and methods: We analyzed the clinical data and the growth parameters of 50 newborns and young infants (age: 1.6 ± 0.9 month) admitted to our hospital (Al Wakhra Hospital, Department of Pediatrics, Doha ,Qatar), between 1-1-2016 to 1-1-2017, with acute meningitis. Anthropometric measurements included weight, length, and head circumference. Length SDS (L-SDS) and body mass-index (BMI) were calculated and recorded at every clinic visit, every 3 months for 8 ± 2 months. Results: In this age group of neonates and young infants with acute meningitis fever (84%) and hypoactivity (64%) were the major presenting manifestations. Acute bacterial meningitis (n: 10) was associated with higher morbidity [shock (n: 1), subdural empyema (n: 1) and hydrocephalus (n: 1)]. Cerebrospinal fluid (CSF) examinations showed that infants with bacterial meningitis had significantly higher pleocytosis of mainly polymorphic leukocytes and protein levels, compared to those with aseptic meningitis All infants showed normal linear growth and weight gain during the follow-up period (8 ± 2 months). The annualized growth rate of infants = 25.3 ± 3.5 cm per year. All had normal length standard deviation scores (LSDS) (-0.2 ± 0.9) and none of them had LSDS < -2. All infants had normal BMI (16.7 ± 1.8 kg/m2). Head circumference growth was normal in 49/50 infants (43.8 ± 1.8 cm) at 8 ± 2 months. One infant developed hydrocephalus after GBS meningitis. There was no statistical difference in linear growth between infants with aseptic and bacterial meningitis. Conclusion: Acute bacterial meningitis in newborns and young infants is still associated with considerably high morbidity and complications. Infantile linear growth appears to be normal in all newborns and young infants with both bacterial and aseptic meningitis.    

scholarly journals Culture Proven Bacterial Meningitis in Children: Agents, Clinical Profile and Outcome

2012 ◽  
Vol 9 (1) ◽  
pp. 36-40 ◽  
Author(s):  
I Ansari ◽  
Y Pokhrel
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Clinical Profile ◽  
Cortical Atrophy ◽  
Acute Bacterial Meningitis ◽  
Influenza B ◽  
Haemophilus Influenza ◽  
Hemolytic Streptococcus ◽  
Young Infants ◽  
Nepalese Children

Background Meningitis is a serious infection. Little is known about the bacterial agents and their antibacterial sensitivity in Nepalese children. Objectives To study bacteriological agents, clinical profile and immediate outcome in patients admitted to children’s ward of Patan Hospital with meningitis. Methods Prospective observational study conducted in paediatric ward of Patan Hospital. All the children admitted to the ward, with the diagnosis of culture proven bacterial meningitis’ on discharge were eligible. Results Out of 7,751 children, 296 (3.8%) had meningitis. This was a group ranging from neonates to adolescents aged 18 years. Only 13 (4.4%) of cerebrospinal fluid samples taken from them yielded positive culture reports. The organisms were pneumococcus (6), Haemophilus influenza ‘b’ (3), ?-hemolytic Streptococcus (1), ?-hemolytic Streptococcus (1), N. meningitides (1) and Pseudomonas (1). Whereas Haemophilus influenza ‘b’ was isolated from young infants, pneumococci were found in the young as well as the old. Fever, vomiting, high leukocyte count with left shift were all commonly present. All but one had cerebrospinal fluid pleocytosis. Low sugar and high protein was found in most specimens. Neuroimaging was done in six children of which three were abnormal (all young infants and pneumococci cases). Ceftriaxone was given to all but one child. Everybody recovered but three had complications – profound hearing loss and cortical atrophy with subdural collection in pneumococcal and septic arthritis with persistence of fever in Haemophilus influenzae ‘b’ meningitis. Conclusion The present study corroborates most of the epidemiological and clinical features of acute bacterial meningitis and sheds light on the causative agents of bacterial meningitis in Nepalese children. http://dx.doi.org/10.3126/kumj.v9i1.6260 Kathmandu Univ Med J 2011;9(1):36-40

Long term sequelae of childhood acute bacterial meningitis in a developing country: A study from the sudan

1991 ◽  
Vol 23 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Mustafa M. Abdalla Salih ◽  
Omer Haroon Khaleefa ◽  
Mohamed Bushara ◽  
Zubair B. Taha ◽  
Zeinab A. Musa ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Developing Country ◽  
Acute Bacterial Meningitis

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

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.

scholarly journals Point-of-care Cerebrospinal Fluid Gram Stain For the Management of Acute Meningitis in Adults: A Retrospective Observational Study

2020 ◽  
Author(s):  
Tomohiro Taniguchi ◽  
Sanefumi Tsuha ◽  
Soichi Shiiki ◽  
Masashi Narita
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Observational Study ◽  
Aseptic Meningitis ◽  
Point Of Care ◽  
Laboratory Data ◽  
Retrospective Observational Study ◽  
Antibiotic Administration ◽  
Gram Stain ◽  
Acute Meningitis

Abstract Background: Gram staining of cerebrospinal fluid (CSF) is widely used in the diagnosis of acute meningitis, but is often conducted in the laboratory, as only some hospitals have access to point-of-care Gram stain (PCGS). The purpose of this study was to demonstrate the clinical impact and utility of PCGS in diagnosing and treating both bacterial and aseptic meningitis in adults. Methods: This was a hospital-based, retrospective observational study at a referral center in Okinawa, Japan. We reviewed the records of all patients aged 15 years or older who were admitted to the Division of Infectious Diseases between 1995 and 2015 and finally diagnosed with bacterial (n=34) or aseptic meningitis (n=97). For bacterial meningitis, we compared the treatments that were actually selected based on PCGS with simulated treatments that would have been based on the Japanese guidelines. For aseptic meningitis, we compared the rates of antibiotic use between real cases where PCGS was available and real cases where it was not. Results: PCGS was the most precise predictor for differentiating between bacterial and aseptic meningitis (sensitivity 91.2%, specificity 98.9%), being superior in this regard to medical histories, vital signs and physical examinations, and laboratory data available in the emergency room. In bacterial meningitis, PCGS reduced the frequency of meropenem use (1/34=3.0%) compared with simulated cases in which PCGS was not available (19/34=55.9%) (p=0.000). In real aseptic meningitis cases, the rate of antibiotic administration was lower when PCGS was used (38/97=39.2%) than when it was not (45/74=60.8%) (p=0.006). Conclusions: PCGS of CSF distinguishes between bacterial and aseptic meningitis more accurately than other predictors available in the ER. Patients are more likely to receive narrower-spectrum antimicrobials when PCGS is used than when it is not. PCGS of CSF thus can potentially suppress the empiric use of antimicrobials for aseptic meningitis.

scholarly journals 1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S510-S511
Author(s):  
Kittipat Aimbudlop ◽  
Sasisopin Kiertiburanakul
Keyword(s):  
Bacterial Meningitis ◽  
Hiv Infection ◽  
White Blood Cells ◽  
Clinical Manifestations ◽  
Hospital Setting ◽  
Polymorphonuclear Neutrophils ◽  
Medical Emergency ◽  
Acute Bacterial Meningitis ◽  
Clinical Presentations ◽  
Acute Meningitis

Abstract Background Acute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis. Methods A retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed. Results A total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm3 increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm3 increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%. Conclusion In this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy. Disclosures All authors: No reported disclosures.

scholarly journals Point-of-care cerebrospinal fluid Gram stain for the management of acute meningitis in adults: a retrospective observational study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Tomohiro Taniguchi ◽  
Sanefumi Tsuha ◽  
Soichi Shiiki ◽  
Masashi Narita
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Observational Study ◽  
Aseptic Meningitis ◽  
Point Of Care ◽  
Laboratory Data ◽  
Retrospective Observational Study ◽  
Antibiotic Administration ◽  
Gram Stain ◽  
Acute Meningitis

Abstract Background Gram stain of cerebrospinal fluid (CSF) is widely used in the diagnosis of acute meningitis, however, it is often conducted in the laboratory, as only some hospitals have access to point-of-care Gram stain (PCGS). The purpose of this study was to demonstrate the clinical impact and utility of PCGS in diagnosing and treating both bacterial and aseptic meningitis in adults. Methods This was a hospital-based, retrospective observational study at a referral center in Okinawa, Japan. We reviewed the records of all patients aged 15 years or older who were admitted to the Division of Infectious Diseases between 1995 and 2015 and finally diagnosed with bacterial (n = 34) or aseptic meningitis (n = 97). For bacterial meningitis, we compared the treatments that were actually selected based on PCGS with simulated treatments that would have been based on the Japanese guidelines. For aseptic meningitis, we compared the rates of antibiotic use between real cases where PCGS was available and real cases where it was not. Results PCGS was the most precise predictor for differentiating between bacterial and aseptic meningitis (sensitivity 91.2%, specificity 98.9%), being superior in this regard to medical histories, vital signs and physical examinations, and laboratory data available in the emergency room (ER). In bacterial meningitis, PCGS reduced the frequency of meropenem use (1/34 = 3.0%) compared with simulated cases in which PCGS was not available (19/34 = 55.9%) (p< 0.001). In aseptic meningitis cases, the rate of antibiotic administration was lower when PCGS was used (38/97 = 39.2%) than when it was not (45/74 = 60.8%) (p = 0.006). Conclusions PCGS of CSF distinguishes between bacterial and aseptic meningitis more accurately than other predictors available in the ER. Patients with bacterial meningitis are more likely to receive narrower-spectrum antimicrobials when PCGS is used than when it is not. PCGS of CSF thus can potentially suppress the empiric use of antimicrobials for aseptic meningitis.

scholarly journals Neurological Complications in Young Infants With Acute Bacterial Meningitis

2018 ◽  
Vol 9 ◽  
Author(s):  
Mei-Hsin Hsu ◽  
Jen-Fu Hsu ◽  
Hsuan-Chang Kuo ◽  
Mei-Yin Lai ◽  
Ming-Chou Chiang ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Neurological Complications ◽  
Acute Bacterial Meningitis ◽  
Young Infants

scholarly journals 16 Variability in lumbar punctures and neuroimaging in infants less than 90 days with acute bacterial meningitis at a provincial children’s hospital in Canada

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e6-e6
Author(s):  
Stephanie Bourne ◽  
Briar Findlay ◽  
Thomas McLaughlin ◽  
Mia Remington
Keyword(s):  
Bacterial Meningitis ◽  
Imaging Modality ◽  
Retrospective Chart Review ◽  
Clinical Indication ◽  
Acute Bacterial Meningitis ◽  
Lower Sensitivity ◽  
Young Infants ◽  
End Of Treatment ◽  
Anonymized Data ◽  
The Common

Abstract Background Bacterial meningitis remains a significant cause of morbidity and mortality in infants, necessitating appropriate and timely investigations and treatment. Despite this, there are no current Canadian practice guidelines outlining the recommended management of infants with bacterial meningitis beyond empiric antimicrobial choice. As bacterial meningitis remains one of the most severe infectious diseases managed by general pediatricians, it warrants an attempt at practice standardization. Objectives The purpose of this study is to review and identify variation in the timing and frequency of lumbar punctures (LPs) and the use of neuroimaging for the management of bacterial meningitis for infants less than 90 days of age at BC Children’s & Women’s Hospital (BCCWH). Design/Methods A retrospective chart review at BCCWH identified confirmed, presumed or possible bacterial meningitis in infants less than 90 days of age over a five-year period (2013-2018). Anonymized data was collected from medical charts, de-identified and stored in REDCap. Results Eighty-one patients were included. Fifty-three percent of all patients had a delay in receiving an initial LP. The most common reasons for delays were that the patient was too unstable (42%) or that the first LP attempt was unsuccessful (26%). Forty-six percent of all patients had only one LP while 36% had at least one repeat LP. Most repeat LPs were done within 7 days of diagnosis. Twenty-nine percent of patients had an end of treatment LPs. Of all patients, 80% had neuroimaging. Head ultrasound (US) was the most commonly used imaging modality for both first image (68%) and subsequent images (64%). Seventeen percent of patients received a CT scan and 15% an MRI as their first image. In most cases, there was no clear clinical indication for imaging noted other than a diagnosis of meningitis (44%). Conclusion This retrospective study confirms that there is variability in the management of bacterial meningitis with respect to lumbar punctures and neuroimaging in young infants. The findings demonstrate LPs are commonly delayed, and suggest a need to develop clearly defined criteria for evaluating instability before an initial LP. Furthermore, the findings raise concern regarding the common practice of ordering head ultrasound for meningitis, given lower sensitivity in detecting disease complications and therefore disputed clinical utility.

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