Neurology

Impaired consciousness, Headache, Raised intracranial pressure, Acute bacterial meningitis, Epidemic meningococcal disease, Viral meningitis, Chronic meningitis, Encephalitis, Rabies, Tetanus, Stroke, Subarachnoid haemorrhage, Subdural haemorrhage, Extradural haematoma, Blackouts/syncope, Space-occupying lesions (SOL), Brain abscess, Hydrocephalus, Epilepsy, Status epilepticus, Cysticercosis, Weak legs and spinal cord disease, Guillain-Barré syndrome, Poliomyelitis (polio), Peripheral neuropathy, Leprosy, Dementia

A study to observe quantitative levels of C- Reactive Protein in Cerebrospinal fluid in patients with Meningitis as an add-on routine investigation- a case-control study

Introduction: C-reactive protein (CRP) is a member of the class of acute phase reactants as itslevel rises dramatically during inflammatory processes occurring in the body. Measuring and chartingCRP values can prove useful in determining the disease progress. Aim: To estimate the CRP level inCerebrospinal fluid (CSF) of patients with meningitis; and to evaluate whether CRP levels could beused to differentiate the various types of meningitis in adults. Materials and Methods: This studywas a case-control study. 80 enrolled patients were subjected to a protocol that included detailedclinical history including duration of illness, symptoms and signs, history or any treatment history.Written informed consent was taken from the patients/guardian. Results: Meningitis was morecommon in the 18-30 years age group. Mean values of CSF CRP were- viral meningitis (2.70 mg/L)and pyogenic meningitis (91.13 mg/L) and control group (1.54 mg/L). CSF CRP can be used as adiagnostic tool to differentiate between pyogenic and viral meningitis as it is significantly raised inpyogenic meningitis in comparison to viral meningitis (p-value <0.0001). Conclusion: CRP in CSF isa valuable, rapid, bedside diagnostic test for differentiating between pyogenic and viral meningitis;with reasonably good sensitivity, specificity and positive predictive value. The absence of CRP in CSFrather than its presence is more important for the diagnosis of viral meningitis.

A Case Report of Late-Onset Neonatal Meningitis Caused by SARS-CoV-2

Introduction: Central nervous system involvement by SARS-CoV-19 appears to be very rare in neonates. We report a case of viral meningitis in a neonate admitted to Kerman Afzalipour Hospital in Southeastern Iran. Case Presentation: The patient was a 15-day-old neonate who presented with lethargy, fever, and poor feeding the day before admission. After the initial evaluation and experimental treatment, viral meningitis was diagnosed with SARS- CoV-19 by polymerase chain reaction (PCR) analysis of cerebrospinal fluid. Empirical treatment was done with antibiotics and supportive care. After viral meningitis was confirmed, the antibiotics were discontinued. In a follow-up two weeks later, the neonate had a good condition with no particular problem. Conclusions: This report is a case of SARS-CoV-2 meningitis in a neonate. Therefore, if there is epidemiological evidence, the central nervous system involvement due to this virus should also be considered in neonates.

Surveillance of West Nile virus infection in Kashgar Region, Xinjiang, China, 2013–2016

West Nile virus (WNV) was first isolated in mainland China from mosquitoes in Jiashi County, Kashgar Region, Xinjiang in 2011, following local outbreaks of viral meningitis and encephalitis caused by WNV. To elaborate the epidemiological characteristics of the WNV, surveillance of WNV infection in Kashgar Region, Xinjiang from 2013 to 2016 were carried out. Blood and CSF samples from surveillance human cases, blood of domestic chicken, cattle, sheep and mosquitoes in Kashgar Region were collected and detected. There were human 65 WNV Immunoglobulin M (IgM) antibody positive cases by ELISA screening, 6 confirmed WNV cases by the plaque reduction neutralization test (PRNT) screening. These cases occurred mainly concentrated in August to September of each year, and most of them were males. WNV-neutralizing antibodies were detected in both chickens and sheep, and the positive rates of neutralizing antibodies were 15.5% and 1.78%, respectively. A total of 15,637 mosquitoes were collected in 2013–2016, with Culex pipiens as the dominant mosquito species. Four and 1 WNV-positive mosquito pools were detected by RT-qPCR in 2013 and 2016 respectively. From these data, we can confirm that Jiashi County may be a natural epidemic foci of WNV disease, the trend highlights the routine virology surveillance in WNV surveillance cases, mosquitoes and avian should be maintained and enhanced to provide to prediction and early warning of outbreak an epidemic of WNV in China.

Volatile Organic Compounds to Identify Infectious (Bacteria/Viruses) Diseases of the Central Nervous System: A Pilot Study

<b><i>Background:</i></b> Central nervous system (CNS) infectious diseases are common diseases in emergency rooms and neurology departments. CNS pathogen identification methods are time consuming and expensive and have low sensitivity and poor specificity. Some studies have shown that bacteria and viruses can produce specific volatile organic compounds (VOCs). The aim of this study is to find potential biomarkers by VOC analysis of cerebrospinal fluid (CSF) in patients with bacterial and viral meningitis/encephalitis (ME). <b><i>Methods:</i></b> CSF samples from 16 patients with bacterial ME and 42 patients with viral ME were collected, and solid-phase microextraction combined with gas chromatography-mass spectrometry was used to analyze the metabolites in the CSF. <b><i>Results:</i></b> There are 2 substances (ethylene oxide and phenol) that were found to be different between the 2 groups. Ethylene oxide was significantly greater in the group of bacterial ME patients than in the viral ME group of patients (<i>p</i> &#x3c; 0.05). In addition, phenol was remarkably increased in the group of ME patients compared with the bacterial ME patients (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> Ethylene oxide and phenol may be potential biomarkers to distinguish bacterial ME and viral ME. VOC analysis of CSF may be used as a supporting tool for clinical diagnosis.

Role of procalcitonin in viral and bacterial meningitis

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.

Epidemiology Profile of Viral Meningitis Infections Among Patients in Qatar (2015–2018)

Background: Little is known about the etiology of meningitis in the MENA region, including Qatar. Viral agents are considered the major cause for meningitis worldwide. Here, we present primary data about the etiology and clinical and demographic characteristics of viral meningitis (VM) in Qatar between 2015 and 2018.Methods: We retrospectively collected data from Hamad Medical Corporation (HMC), which provides about 80% of healthcare services in Qatar. Data were collected for the period between 2015 and 2018. During this time period, 6,705 specimens were collected from patients with suspected meningitis attending HMC and primary healthcare centers. These specimens were tested for a panel of viruses using the “FTD Viral meningitis” multiplex real-time PCR kit that detects Adenovirus (ADV), Human herpesvirus 1&amp;2 (HSV1 and HSV2), Epstein–Barr virus (EBV), Enteroviruses (EV), Cytomegalovirus (CMV), Varicella zoster virus (VZV), and Parechovirus (PV).Results: Only 10.9% (732/6,705) of all suspected meningitis cases were caused by viral agents. 60.9% of the reported cases were males, compared to 39.1% in females. Most of the infections (73.9%) were reported in children younger than 10 years of age. EV were identified as the main causative agent (68.7%), followed by EBV (7.5%) and ADV (6.8%). Other viral agents including VZV, PV, HSV-1, and HSV-2 were also detected with a lower frequency. Confirmed VM were more prevalent among Qatari subjects compared to other nationalities. We observed no specific seasonality of viral agents, but a slight rise was recorded during the spring seasons (March to June). Fever (59.4%, 435/732) and acute central nervous system (CNS) infection (15.6%, 114/732) were initial symptoms of most cases.Conclusion: This is the first report about the molecular epidemiology of VM in Qatar. In line with the international records, our data showed that EV is responsible for 68.7% of Qatar's VM cases. Further studies are needed to genotype and serotype the identified viruses.

Clinical features and management strategies of Meningitis in adult patients: A hospital based study from Kuwait

Introduction: High mortality rate of meningitis has been reported in Kuwait, however, limited data is available describing this disease in adult patients. With this background, we conducted a prospective study on patients admitted with meningitis, with an objective to describe the risk factors, clinical presentation, disease course and outcome; focus given on diagnostic problems and consequent management difficulties. Methods: Our team diagnosed, managed and documented hospital records of patients (n=44) admitted with suspected meningitis at a referral hospital during 2010-12. Detailed information was collected regarding clinical presentation, CSF analysis, treatment, hospital course and outcome as per Glasgow Outcome Scale (GOS). Results: Bacterial, viral, and tuberculosis (TB) meningitis were seen in 22.8%, 52.3%, and 15.9% of patients. Clinical features of our cohort were consistent with available literature. Positive identification of organism by culture, gram stain, or antigen test was possible in only 6 patients i.e. Streptococcus pneumonae-(n=3), Streptococcus agalactiae-(n=2), Neisseria meningitides-(n=1). CSF polymerase chain reaction was detected positive for Enterovirus RNA, and Herpes simplex virus DNA for one patient each. Empirical antimicrobial treatment directed against common causative organisms was the mainstay of management of bacterial meningitis. Viral meningitis was managed symptomatically. TB meningitis patients were administered anti-tubercular treatment. As per GOS, 38(85.4%) patients recovered with no neurological deficit. Six patients recovered with mild to moderate deficit. Conclusion: Low positive culture rates and inability to identify pathogens have been a diagnostic challenge faced by our team. Strong clinical suspicion, early empiric antibiotic and dexamethasone therapy perhaps contributed to very good recovery in our study. Keywords: Meningitis, Kuwait, Clinical Suspicion, Antibiotic, Dexamethasone